The effect of template-based sequential (TBS) coding on an NHS plastic surgical practice

Publication date: Available online 1 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ruben Y. Kannan, Catriona Neville, Tamsin Gwynn, Vanessa Venables, Raman Malhotra, Charles Nduka
IntroductionClinical coding is often a mystery to us surgeons but in actuality, it has a huge bearing on the financial sustainability of our services. Given the rapid innovations in plastic surgical procedures, clinical coders often struggle to decipher the extent of surgery. Meeting midway is the way forward here.MethodsIn a prospective audit over a six-month period, we analysed data from 2586 patients' in our practice; a combination of general plastic surgery and specialist facial reanimation services. This involved comparing data from the first three months' where coding was performed by clinical coders' based on operating notes per se (phase I) and the subsequent three months' when the operating surgeon filled in the OPCS 4.7 (version 2014) codes at the time of completing the operating notes and the clinical coders' then vetted this information (phase II) as part of a sequential TBS coding system.ResultsIn terms of out-patient income, there was a 3% increase in facial palsy income and 6% increase in general plastic services but the most significant improvement was in terms procedural income per case. General plastic surgery cases saw an increase of 49% while facial palsy income increased by 58% over the same period. Greater insight into OPCS and HRG codes also allowed for the calculation of the actual tariffs for specific procedures.ConclusionsHaving the operating surgeon as the primary coder, using a template, with subsequent vetting by the clinical coders, improves data capture which in turn, increases income. Future recommendations includes the use of proforma-based operating notes for workhorse procedures.



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