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Financial Improvement Programme: Recognising the Importance of coding

July 23, 2024

The Financial Improvement Programme is committed to improvement across all facets of Trust operations.

2024/25 plans: With a target of £44.1m this year, cost reduction is the key focus of the improvement programme. However, this week we are excited to share a significant opportunity to optimise clinical income via coding improvements.

What is clinical coding? When a patient attends a hospital appointment, we may undertake procedures such as an ECG, take blood, or perform other diagnostic tests for which the Trust is paid.

As part of the Income/Tariff/C workstream, several opportunities have been identified to optimise our income from clinical coding. The Performance and Insight team and the Finance team have estimated the Trust may benefit from an additional £6m of income. The teams have undertaken various reviews and benchmarking as part of the workstream scope.

The two main reviews are:

  1. Secondary Uses Service (SUS) review
  2. Clinical equipment review of outpatient procedures (OPPROCS).

SUS is the single, comprehensive repository for healthcare data through NHS Digital, enabling a vast range of reporting and analyses. The Performance and Insight team have created a national average of OPPROC income by directorate. This benchmark has enabled analysis of SWB performance against the national average. Analysis of SWB activity at the specialty level has identified unwarranted variations—this has formed the basis of the opportunity for coding improvement.

The clinical equipment review, on the other hand, has helped identify potentially missed coding for outpatient procedures (OPPROCS). Procedures carried out within an outpatient attendance generate income based on a tariff associated with the clinical code for the procedure. (Note: While systems are in place to ensure income for the most common equipment, some directorates such as dermatology and ophthalmology use specific equipment that is not already within the EPR environment).

We need your support: A clinical coding auditor is on site this month to audit the identified coding potential and embed relevant protocols at each service point. We ask all colleagues to engage with the auditor, as this will help maximize the benefit from the coding improvement exercise.

For more information, please email Berenice.Lufton@nhs.net or call 07969 609842.