The NHS is a beautifully complex machine, of which frontline staff are generally the most visible and known part. Many other essential roles, however, are not often in the spotlight, like the Clinical Coder.
Grace Amadi is the Head of Clinical Coding at the Luton and Dunstable University Hospital, and she told us why the work of the Clinical Coders is so important.
When they hear about NHS funding, people may think every hospital just gets a lump sum to run for the year, but it’s way more complicated than that. Hospitals are “paid by result” by the Clinical Commissioning Groups (CCGs), which means that the funds they receive are linked to the services they have provided. This money pays for bills, equipment, staff and more.
Our job is to piece together and record everything that happens to a patient at the hospital, what we call ‘episode of care’, from arrival to discharge, and to translate each step into international and national codes called ICD-10 and OPCS-4 classifications. These are then used by accountants to work out how much the hospital needs to receive in reimbursement from the CCG. There are thousands of such codes, printed in several tomes and guides, which have been developed by the World Health Organisation to cover diseases, interventions and procedures in painstaking detail. No coder is ever more than a foot away from them!
To give you an example, a male patient with asthma that came in to get stitches to his left arm after cutting himself with a knife in the kitchen, and was then discharged without antibiotics, to a coder, is: T11.1, Y28.9, J45.9, S42.1, Z50.1, Z94.3
Once patients have been discharged, all their medical records are passed to a Clinical Coder who patiently runs through them, looking for any recorded acute and chronic conditions, any scan or exam performed, treatment administered and so on. If there are gaps in a patient’s clinical history, the Coder, like a detective, goes on the hunt for the missing information until everything checks.
There is no room for error in our job, not just because the hospital could lose funds, but because our records represent the definitive and detailed history of what happened to a patient in our hospital. They are also used as evidence in internal investigations and in court.
Everything is then translated into clinical codes, goes through quality control and it’s passed to the Finance department who invoice the CCG. I am very proud of my team and the work we do.