Author: 
Dinesh Nagi, Chairman ABCD
Date of the announcement: 
Wednesday, 21 March, 2018
Body: 

 

1. Always include “diabetes” as a diagnosis in inpatients

  • Even if not the primary reason for admission, specify that the patient has diabetes and the specific type.
  • This affects the complication score (the “cc score”) affecting income.

2. Always include diabetes related complications in the list of diagnoses in inpatients

  • Even if not directly relevant for the reason of this admission.
  • For example, by including “diabetic retinopathy” to the list of diagnoses, the “cc score” increases, even if the admission is for an unrelated condition.

3. Always ensure that the relationships between diagnoses are clear in inpatients

  • This is important in how the coders code diagnoses; this affects income.
  • Use linking words such as “due to” or link e.g. ‘diabetic retinopathy’
  • For example, “foot ulcer due to diabetes” is better than “Foot ulcer. Diabetes.”

4. Ensure that diabetes complications are listed as diagnoses in inpatients

  • Even if these are not directly related to the reason for admission.
  • Each of these will add to the “cc score” and potentially to the income.
  • For example, include “diabetic retinopathy” or “diabetic nephropathy” even if this is not the reason for admission.

5. Explicitly state whether MRI, CT scans or Echo’s are performed

  • CT and MR scans are “unbundled” and paid for separately.
  • So explicitly specify these.

6. Be clear about procedures in podiatry

  • Code site and laterality (and approach) to optimise income.

7. Bariatric surgery – code obesity as a secondary code

  • Specify “obesity”. Don’t simply specify the BMI.
  • Again, this optimises income.

8. Take care about how to express uncertainty

  • Don’t use “query”, “possible” or “?” if you want to code that diagnosis
  • For example, coders cannot code “?diabetes” as diabetes.
  • ‘Probable’ or ‘treated as’ are acceptable

9. Commissioners can use a programme budgeting code for diabetes or endocrinology

  • PBC 0204A for diabetes
  • PBC 0204B for endocrinology
  • This allows commissioners to aggregate the costs of relevant diabetes or endocrine inpatient codes. This is only as good as the data provided.

10. Ensure that outpatient MDT clinics are coded accurately

  • Income from MDT clinics (more than one professional seeing the same patient in the same room at the same time) is considerably more than for seeing a “single professional” in a clinic.