Outcomes of a five-year quality improvement project to improve coding accuracy for children's spinal procedures

After the relocation of paediatric spinal surgery services between specialist centres within the same region, monetary rebates for spinal procedures declined, despite consistent case volumes. A long-term quality improvement initiative was undertaken to enhance coding accuracy and ensure correct remuneration.

A five-year quality improvement project, consisting of three cycles, was undertaken to assess paediatric spinal procedures and related coding practices. Procedures were reviewed and given "optimal" codes by clinicians from the spinal deformity team, and mock rebates were generated. These were compared to actual codes and rebate values from the new site. Meetings were held with lead coders at the new site, and instruction was provided on how to more accurately code spinal procedures. A spinal coding operation manual with lay descriptions of spinal procedures and coding advice was developed.

Rebate accuracy rose from 82.16% to 98.40% over the course of the project (p = 0.007). The mean difference between actual and optimal coding rebate fell from -£4,243.16 to -£264.42. The overall accuracy of clinical coding rose from 37.8% to 70.0% (p = 0.003).

This long-term quality improvement project significantly increased the accuracy of clinical coding for paediatric spinal procedures and, when extrapolated to a mean of 150 cases per year, has generated an annual saving of approximately £596,811.00 for the site. This methodology can be easily replicated in institutions facing similar issues.