Amy Smith
Introduction
Accurate surgical coding is essential for hospital reimbursement and clinical audit. The OPCS system standardises procedure recording within the NHS, but discrepancies can arise anywhere between booking and final clinical coding. This study evaluated the accuracy of theatre-assigned OPCS codes and their financial implications.
Methods
A retrospective review of all elective General Surgery and ENT procedures over two weeks at a single day surgery unit. Booking and theatre-assigned OPCS codes were compared with final codes assigned by clinical coding. Discrepancies were categorised as alternative, incorrect, omitted or extraneous codes. Financial impact was estimated using NHS Payment Scheme tariff ranges. Fisher’s exact test compared discrepancy rates between specialties (p<0.05).
Results
58 procedures were analysed (37 General Surgery, 21 ENT). In General Surgery, 31/37 procedures (84%) contained discrepancies: mainly due to alternative codes (32%), and omitted additional codes (37%). In ENT, all 21 cases (100%) demonstrated discrepancies, most commonly due to alternative (76%) and omitted codes (71%). Discrepancies were more frequent in ENT than General Surgery (100% vs 84%; p=0.047). Financial modelling estimated a mean tariff difference of £197 per case (95% CI £115–£279), corresponding to an estimated total financial variance of £11,426 (95% CI £6,670–£16,180) over the study period. Extrapolated to annual activity, discrepancies may result in an estimated financial variance of £296,000 (95% CI £173,000–£421,000).
Conclusion
Significant discrepancies exist between theatre-assigned and final OPCS coding. Improved operative documentation, targeted staff education, and collaboration between theatre teams and coding departments may improve accuracy and reduce financial risk.
Authors
Amy Smith, Surgical Hub Llandough, Cardiff and Vale University Health Board, Cardiff, United Kingdom
Arwel Poacher, Cardiff University, Cardiff, United Kingdom
Naomi Lee, Surgical Hub Llandough, Cardiff and Vale University Health Board, Cardiff, United Kingdom
Ryan Trickett, Cardiff and Vale University Health Board, Cardiff, United Kingdom