Description
In this detailed talk, Ashley Cole addresses essential topics surrounding healthcare coding and billing, focusing particularly on spells, finished consultant episodes (FCEs), and healthcare resource groups (HRGs). He introduces the Grouper software, which allows users to input ICD-10 and OPCS codes to identify corresponding HRGs, underscored as an algorithmic tool in healthcare coding. Cole differentiates between FCEs and spells, with spells detailing patient admissions under single or multiple consultants and lays out how payment mechanisms work based around the concept of spells.
The presentation progresses to HRG classification, consisting of 85 chapters, with specific attention on chapters regarding orthopedics and trauma. Cole describes the intricacies of HRGs, their structure, and the number of HRGs that pertain to various procedures and diagnoses, emphasizing the relevance of clinical guidelines and diagnostic codes. He explores HRG segmentation by complications and co-morbidities, illustrating how these factors influence length of stay and tariffs.
Ashley further clarifies how multiple surgical procedures can escalate the HRG, often affected by primary diagnoses. He discusses the impact of age, admission type (elective vs emergency), and length of stay on tariff calculations—elucidating the role of market forces in determining hospital running costs, supported by examples and statistical data.
Cole offers a summary reiterating the complexity of HRG tariffs and stresses collaboration between clinical professionals and coding specialists to ensure accuracy and efficiency in patient care documentation. He concludes with a call to action for healthcare professionals to engage with their coding teams and finance directors to improve the overall system.