G178(P) Discharge letters and coding: Improving incomes as well as outcomes

Aims In the current financial climate, optimal healthcare must be both excellent and cost-effective. We aimed to introduce concepts of coding to the departments’ trainees to improve income for the trust. We reviewed the quality of Electronic Discharge Letters (EDLs) to assess their effect on financial reimbursement, using bronchiolitis, a common, seasonal condition which usually follows a set course, as an example code. Methods Two cohorts were analysed, with data collected retrospectively. All bronchiolitis patients admitted to the paediatric ward in December 2013 and December 2014 were included. We gave guidance to the departmental trainees on improving EDLs to aid coding before the second cohort. EDLs were reviewed for the codes assigned and the tariffs subsequently provided. Income generated by each cohort was then compared. Results The 2013 cohort comprised 71 patients, earning a total of £71,982, a mean of £1013.83 per patient. 54 patients were recruited in 2014. As is routine, tariffs were reduced globally by the CCG by an average of 1.2%. After correcting for this, the 2014 cohort earned £67,845, a mean of £1256.38 per patient. Conclusions The second cohort received a higher financial reimbursement on average. This may have been partly due to increased awareness of coding whilst writing EDLs, enabling the coding team to code more accurately. However, extraneous factors such as improved experience of the coders, or improved documentation in notes may have also played a role. Documentation of comorbidities and complications on EDLs also impacts on income for the Trust. Tariffs are calculated based on “principle” and “secondary” diagnoses, so the numerical order in which these are documented on EDLs can affect reimbursement. In this audit, ambiguous documentation of diagnoses prevented accurate coding, thereby accounting for significant losses e.g. recording URTI rather than bronchiolitis, which carries a different tariff. Microbiological confirmation of RSV did not increase the tariff for bronchiolitis, whereas isolating metapneumovirus increased the tariff by £1000, thus testing in severe cases may be beneficial. In feeding back to the department, the authors gave additional training in coding and recommended this audit be applied to other patient groups.