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Two codes - 240 per cent price difference

Our commissioner at the coalface has been looking at coding validation and is aghast at the price differences

Our commissioner at the coalface has been looking at coding validation and is aghast at the price differences

Our commissioning locality has had a brief foray at payment coding validation for non-elective admissions. We compared real life patient specific codes to the actual patient discharge letters . The audit was small and deemed unsupportive of further investment. But I still feel there are opportunities here, though it is a very complex area.

I bet no single individual has a full grasp of these codes and the clinical situation . I think that person would have to be a doctor who is very skilled and experienced in HRG coding and a few of the more productive Asperger's traits would help too.

For instance , what justification can there be for and how does one really clinically differentiate between:

DZ 22C ( Unspecified Lower Respiratory infection without CC ) …..at £776

DZ 23C ( Bronchopneumonia without CC )…………………………….at £1,250

Maybe I am just showing my ignorance here - or perhaps the Emperor really isn't wearing clothes.

And heaven forbid they arrived with a diagnostic label of COPD without NV or CC….. at £1,849

I doubt there is much to separate these with respect to treatment costs, yet one is charged at 240% of another.

One wonders if in the brave new world of GP consortia, coding analysis and challenge could be paid for on results achieved, perhaps a savings outcome related pay scheme. I suspect this area of activity would be ripe for outsourcing.

It would also be really effective if discharge letters contained the pricing codes and costs. Not only would this bring home to GPs the real cost of an admission but would let them ensure the right code had been applied. If a percentage of savings could be retained by the practice I bet GPs would soon get pretty skilled at differentiating a DZ 22C from that very different animal , a DZ 23C.

dr clive henderson

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