A day in the life of… a clinical coder - by Laura Hickey, Professional Lead for Coding at CHKSWhenever I am asked about my job, I am met with blank stares or an assumption I work in IT. Clinical Coder certainly doesn’t ever appear on any drop down lists of occupation, which makes getting insurance quotes interesting.

Clinical coding has nothing to do with computer programming. I normally try to explain it as the translation of medical and surgical information into something that the accountants can understand. The focus of clinical coding in the NHS is now primarily about money, because the payment that hospitals receive is based on the patient information we code. However from a coder’s point of view it is more about using codes to provide an accurate and complete story of a patient’s time in hospital.

Let’s take a standard operation like a knee replacement as an example. If the main reason for the replacement was osteoarthritis of the knee we would call that the primary diagnosis and code that as gonarthrosis using the code M179. Diagnoses are coded using ICD-10, which is an international classification developed by the World Health Organisation and contains thousands of codes covering diseases, causes of illness and other factors influencing healthcare.

All other illnesses or pre-existing conditions (called comorbidities) that affect a patient’s care, such as warfarin use, should be captured with a code. The diagnosis code for a patient using anticoagulants is Z921. As ICD-10 is an international classification, there are many codes which I have never used, like the effects of a tsunami or earthquake.

We also code the procedures the patient undergoes when they are in hospital. Unlike diagnosis coding, procedure coding varies from country to country; in the UK we use OPCS codes. A knee replacement would be coded as W401(primary total prosthetic replacement of knee joint using cement) plus Z942 to indicate which knee it was (the right one).

The payment a hospital receives for a cemented knee replacement is about £6,000. However, if the coder misses out the code for warfarin use, the price drops by £668. As a result there is a lot of scrutiny from finance teams on our work.

Like almost all clinical coders I began my career in a clinical coding team within the NHS, where I learnt the complex rules of applying and sequencing codes and attained my National Clinical Coding Qualification. I now work for CHKS delivering clinical coding to NHS trusts and private healthcare providers, providing full coding services as well as helping to clear backlogs and cover absences.

Coding for private providers is very different than coding within the NHS. The medical records tend to be in better order and if there is any missing documentation or anything that needs clarifying we simply return it to the hospital for them to find the information. In the NHS the responsibility for providing complete information for coding is a lot less clear, and often NHS coders have to go on a hunt for the information themselves.

At CHKS I am the Professional Lead for Coding. I support our team of coders in their day-to-day work, and I work with our clients to ensure our work is of a high quality. I also help clinicians understand what information we need in order to assign the most accurate codes. We work on the basis that if it’s not documented, it didn’t happen so it’s really important that all the information relevant to a patient’s stay is clearly documented. Even when it is coding often requires a little further detective work from the coder. Working closely with consultants not only ensures that the coding is top quality but also helps coders develop a better understanding of the procedures being performed.

Although I am often out working alone, being part of a national team who all work on various projects with different clients means that I have a wealth of knowledge and experience to draw on and someone is always only an email or phone call away. We also have a process of peer-review and scrutiny which means we produce the best work we can and that individually we are always improving.

What I like best about my job is that I’m often at a different hospital every day, and every day brings new and interesting challenges. I never know if I’ll be dealing with endoscopies, new born babies or triple heart bypasses. It also gives me an opportunity to discuss my work with a wide variety of clinicians, from surgeons to midwives, which gives me a deep understanding of the conditions and procedures I code.

I especially like finding new procedures I’ve never come across before. Yesterday it was the gastrocnemius slide, which I now know involves cutting the bulging muscle on your calf and sliding the cut ends over one another to lengthen the muscle. Or as a coder would say: T70.5, Z58.1, Z94.-

About the coding and and financial assurance team at CHKS
We are the largest private provider of healthcare clinical coding and data quality services in the UK. Our focus is on data and payment accuracy in healthcare. For more information about CHKS Clinical Coding, Data Quality and Financial Assurance Services, please click here.

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Whenever I am asked about my job, I am met with blank stares or an assumption I work in IT. Clinical Coder certainly doesn’t ever appear on any drop down lists of occupation, which makes getting insurance quotes interesting.
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