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Clinical Coding Management

Reference: 24-25446

Date response sent: 29/01/2024

Details of enquiry

I’m interested in how your Trust currently manages clinical coding. Could you please answer the following:

  1. How many clinical episodes does your Trust record on average each month or over an annual period?
  2. What is the size of your clinical coding team?
  3. Is the coding team focused on coding clinical episodes within inpatient, outpatient, or A&E (Emergency Care) – or all of the above? Any other settings or niche areas that are coded by this team?
  4. On average, how many systems do coding teams need to access and review to code a typical episode?
  5. What is the average time spent on coding a clinical episode?
  6. What is the maximum time spent on coding a clinical episode?
  7. On average, what number or percentage of episodes go uncoded?
  8. On average, what number or percentage of episodes are not coded to sufficient detail?
  9. What are the main reasons why episodes go uncoded or are not coded to sufficient detail?
  10. Who is the budget holder for clinical coding team and/or what is their role?

Response sent

Your request for information is not entirely applicable to our Trust, the Tavistock and Portman NHS Foundation Trust as we do not code our patient sessions in the way that acute Trusts would code, and this is explained further below.

The Tavistock and Portman NHS Foundation Trust is a small specialist outpatient mental health Trust, providing mainly psychological services via talking therapies. We do not provide acute services, nor inpatient patient services.

  1. CAMHS (Child and Adolescent Mental Health Services)

We do not diagnose children and do not use clinical coding for this group of patients as our child and adolescent mental health services are delivered in line with the THRIVE Framework for system change, which means that our services are delivered according to need rather than a specific diagnosis. We developed the framework in our services, which takes a no wrong door, population based approach to the delivery of CAMHS. Further information about the THRIVE Framework and the implementation approach can be found here: www.implementingthrive.org.

The Trust uses SNOMED CT, which is a structured clinical vocabulary integrated within our electronic patient record and is not therefore separately inputted. The Trust confirms that your 10 point questionnaire below therefore is not applicable to CAMHS as this department does not undertake the clinical coding to which your questions relate.

 

  1. Adult Mental Health Services

Diagnostic codes do not form part of Trust’s specialist psychoanalytic and psychodynamic based approach to the Trust’s work with adults, so we do not use them within our adult mental health services.

The Trust uses SNOMED CT, which is a structured clinical vocabulary integrated within our electronic patient record and is not therefore separately inputted. The Trust confirms therefore that your 10 point questionnaire below is not applicable to our adults mental health services as this department does not undertake the clinical coding to which your questions relate.

  1. Adults Gender Identity Clinic

The (adults) Gender Identity Clinic undertake ICD11 clinical coding, and for this service alone, our answers to your questionnaire are as follows:

  1. How many clinical episodes does your Trust record on average each month or over an annual period?

The Adults GIC would code each clinical session occurring in that month. This would not be a dedicated activity and would form part of the clinician’s write-up of the patient session. Approximately 700 clinical sessions are attended per month.

  1. What is the size of your clinical coding team?

Not applicable. The Trust does not employ any dedicated clinical coders.

This is a devolved activity, across the GIC service and forms part of the business as usual activities of operational and clinical staff, when writing up the patient notes/episodes into the EPR (electronic patient record).

  1. Is the coding team focused on coding clinical episodes within inpatient, outpatient, or A&E (Emergency Care) – or all of the above? Any other settings or niche areas that are coded by this team?

See our responses to Q2 above.

  1. On average, how many systems do coding teams need to access and review to code a typical episode?

Not applicable – the coding of ICD11 diagnoses is inbuilt into our EPR, Carenotes, see our response to Q2 above

  1. What is the average time spent on coding a clinical episode?

Minimal – a few seconds – because this is part of writing up the standard assessment by the clinician.

  1. What is the maximum time spent on coding a clinical episode?

See our response to Q2 above

  1. On average, what number or percentage of episodes go uncoded?

Nil – our EPR system is such that a diagnosis (and its code) must be entered, otherwise it will not save the episode notes

  1. On average, what number or percentage of episodes are not coded to sufficient detail?

Not applicable – see our response to Q7 above

  1. What are the main reasons why episodes go uncoded or are not coded to sufficient detail?

Not applicable – see above response

  1. Who is the budget holder for clinical coding team and/or what is their role?

Not applicable – see our response to Q2 above

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