Can radiology pay its way? the key is in the coding…

Created - 05.08.2018

Even if you’re hungry for a new project with a mind open to ideas, the mention of coding is probably not going to set ablaze an ambition to kick-start your own coding improvement project.

I’ll admit my own initial enthusiasm was somewhat limited. But if you’re interested in a making a small change which could transform your departmental income, then coding is something you should definitely be interested in. To get you started we’ll try to outline easy ways to optimise coding in your department.

It’s probably worth mentioning that if you increase your departmental income through coding improvements, hospital management aren’t going to drop off a case full of money at your office. Which is obviously a great shame. But increasing your coding income can massively impact future contract negotiation for your department. This can in turn leave you with a greater pot of money to improve your department in many ways. Whether it’s employing more staff, replacing equipment or trying new procedures, income can influence what your department can do now, and in the future. With this in mind, due to a wide variation in practice between hospitals, first of all liaise with your managers and clinical coders to enable you to understand your local system.

The next most important step is making sure your activity is being recognized at all! For example, even if you perform a procedure on a patient and they are admitted under vascular surgery, the payment for that procedure will most likely go to their department rather than IR. If you have a day case unit this is less likely to happen, but ultimately who the patient is admitted under on the patient administration system, and which Consultant’s details go on the discharge summary are key,

The principle of coding itself is simple; coders combine procedural details (OPCS 4.8) with patients’ primary diagnosis and comorbidities (ICD-10) to produce a cash sum/ tariff of reimbursement. Obviously the procedure you perform affects the money you get back. But you’d be surprised at how much comorbidity status can influence the tariff for certain procedures- we certainly were. For example- reimbursement for a day case peripheral angioplasty increases from £1150 for a patient with 0-2 comorbidities, to £4711 for patients with over 9 co-morbidities. And when you consider that you get points for things like hyperlipidaemia, diabetes, a foot ulcer, requiring additional assistance moblising, or nicotine dependence, you can see how quickly the comorbidity tally can stack up.

For our project we therefore decided to focus on day case angioplasty and optimising co-morbidity coding for these patients. We figured this would be a high yield area to focus on; firstly because as we’ve seen, comorbidity affects reimbursement to a large extent, but also because it is likely to be inaccurate and underscored (the form is completed by busy IRs between cases!).

We did this by retrospectively reviewing the electronic and paper notes of all patients having a day case angioplasty over a two week periodthere were 15 cases in total. We then calculated how many comorbidity points they should ideally have accrued, and worked out their corresponding tariff. By comparing this with the tariff they actually received, we calculated how much cash we were missing out on.

Average income increased by £1,191.46 per patient (range £0-3,839). Over two weeks, this amounted to an extra £15,489. Extrapolated over a year, this resulted in an increase of £402,714 (based on the assumption at least 338 peripheral vascular procedures will be performed annually).

By firstly increasing awareness amongst IRs completing the co-morbidity information, and secondly by working closely with the Coding department we hope to vastly increase our departmental income over the next year.

In summary IR can pay its way, but the key is in the coding. It can be easily optimized and it can affect your departmental income dramatically. So reach out to your Coding department and see if you could save/ make your department a metaphorical case full of money.

Dr David Flowers Consultant Interventional Radiologist Portsmouth Hospitals Trust

Dr Drew Maclean Southampton University Hospitals Trust