Editor’s blog Friday 27 August 2010: Audit Commission report on coding accuracy

You may already have seen the new report from the Audit Commission on the quality of NHS PBR clinical data coding.

The press release states that "coding errors are fewer than in 2007, when the Audit Commission began checking the Payment by Results (PbR) system ...  the average clinical coding error rate has dropped from 16 per cent to 11 per cent in three years" adding that "some £9 million (about 5 per cent) worth of financial errors have been spotted".

Andy McKeon, the Audit Commission’s Managing Director, Health, while describing the improvement trend in clinical coding as "reassuring", added, "the variation in error rates from trust to trust is a concern. There are clear ways in which trusts can improve and we’ll be focusing our 2010/11 clinical coding audits on the trusts that most need help. We will also be auditing the costing submissions of acute trusts that underpin the tariff and which are also used in local price negotiations".

The auditing of trusts' costing submissions that underpin the tariff is a crucial role as the NHS deals with sustained austerity. The timing of the Coalition Government's decision to abolish the Audit Commission could scarcely be less helpful.

Still no gaming
The release also emphaises the "key finding ... that there remains no evidence of systematic ‘gaming’ in the system, in other words, NHS trusts purposely using wrong codes to get extra money for treatments that were not provided, or charging for a more expensive treatment than was provided. On the sample audited, NHS trusts have slightly undercharged primary care trusts (PCTs) for their work in 2009/10".

It does, however, highlight significant variation locally, noting that in more than a quarter of trusts audited, PCTs would pay 2 to 8 per cent more for some treatments if the NHS trust had coded them accurately. The gap between the best and worst trusts at clinical coding has narrowed. But the range from 0 to 28 per cent is still high.