Case Number 3685
Request Date 03/07/2014
Completion Date 07/08/2014

 

Details of the Request

  1. Please supply structure of your Clinical Coding Dept
     
  2. How many FCE’s per year do you have?
     
  3. How many Coders do you employ broken down into Bandings ( If not detailed in 1 above)
     
  4. Do you code totally from the full Medical Record or an EPR?
     
  5. How many separate systems are used to contribute to the Coding process by system e.g. Radiology systems, Laboratory systems?
     
  6. Who by and how are mortality reviews undertaken within your Trust?
     
  7. Do you have a qualified Clinical Coding Trainer or Clinical Coding Auditor?
     
  8. Do you have an encoder?
     
  9. Is the Clinical Coding Dept a centralised function?
     
  10. Do the Coders visit wards to gather the coding information?
     
  11. Are your Coders speciality specific
     
  12. Do you have Coding runner/porters that support note delivery to the Coding Team
     
  13. Please supply a copy of your last PbR Coding Audit

 

Details of the Response

1. Please supply structure of your Clinical Coding Dept

Please see attached

 

2. How many FCE’s per year do you have?

The Trust has around 86,000

 

3. How many Coders do you employ broken down into Bandings ( If not detailed in 1 above)

 

 

4. Do you code totally from the full Medical Record or an EPR?

The Trust codes Full Medical Records

 

5. How many separate systems are used to contribute to the Coding process by system e.g. Radiology systems, Laboratory systems?

The following systems are used to contribute to the Coding process: Trust PAS System, Encoder, Histopathology, Theatre System, ITU System, OPAL OPD Clinic Letters

 

6. Who by and how are mortality reviews undertaken within your Trust?

Mortality reviews are undertaken by Trust Mortality Lead Coder & Coding Manager through a monthly review with queries validated by Clinicians

 

7. Do you have a qualified Clinical Coding Trainer or Clinical Coding Auditor?

Yes, the Trust has two of each.

 

8. Do you have an encoder?

Yes

 

9. Is the Clinical Coding Dept a centralised function?

Yes, apart from Obstetric & Neonatal Coders embedded within its specialty directorate (1.5WTE, not included in the structure provided)

 

10. Do the Coders visit wards to gather the coding information?

Occasionally the coders visit wards to gather the coding information.

 

11. Are your Coders speciality-specific?

No, all trained and qualified staff undertake coding of all specialties.

 

12. Do you have Coding runner/porters that support note delivery to the Coding Team?

Yes, 2 WTE Band 2 staff.

 

13. Please supply a copy of your last PbR Coding Audit.

Please see attached