This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at http://www.theguardian.com/healthcare-network/2015/jul/17/clinical-coder-like-being-detective-nhs
The article has changed 3 times. There is an RSS feed of changes available.
| Version 1 | Version 2 |
|---|---|
| Working as a clinical coder in the NHS is like being a detective | |
| (about 3 hours later) | |
| It’s Monday morning. I get up with enough time to get ready but never any to spare. I exchange “good day” wishes with my girlfriend and I’m off; it’s 7am. My journey takes just under an hour, largely by tram. I always listen to music but never read; there’ll be plenty of that throughout the day. | It’s Monday morning. I get up with enough time to get ready but never any to spare. I exchange “good day” wishes with my girlfriend and I’m off; it’s 7am. My journey takes just under an hour, largely by tram. I always listen to music but never read; there’ll be plenty of that throughout the day. |
| I log on and check my emails. My manager warns that last week’s time sheets need to be submitted before 10am; a consultant writes, “Yes always Doxorubicin” in response to a three-paragraph email I sent, someone has won the staff lottery, a colleague wishes me a good weekend (sent 10 minutes after I’d left on Friday). | I log on and check my emails. My manager warns that last week’s time sheets need to be submitted before 10am; a consultant writes, “Yes always Doxorubicin” in response to a three-paragraph email I sent, someone has won the staff lottery, a colleague wishes me a good weekend (sent 10 minutes after I’d left on Friday). |
| For most people the word “coding” conjures images of computer programming. Our job advertisements are often met with enthusiastic applications from ambitious IT graduates who haven’t read the specification. Prefix “coding” with “clinical” and it’s something completely different. | For most people the word “coding” conjures images of computer programming. Our job advertisements are often met with enthusiastic applications from ambitious IT graduates who haven’t read the specification. Prefix “coding” with “clinical” and it’s something completely different. |
| My job mainly consists of reading through patients’ medical records – that’s everything that documents their hospital stay, from admission to discharge – and converting the information into alphanumeric codes using the ICD-10 and OPCS-4 classifications that the NHS then uses to set resource-management targets and receive reimbursement for treatment and care. Rules can be very complex and strict; it’s essential to keep up-to-date with policies and procedures. I think of myself as a detective; collecting, arranging and presenting evidence. For a history graduate, too awful at chemistry to fulfil my aspirations of becoming an ophthalmologist, it’s perfect. My coding career was an accident – a logical but ambitious step for a medical records filing clerk. | My job mainly consists of reading through patients’ medical records – that’s everything that documents their hospital stay, from admission to discharge – and converting the information into alphanumeric codes using the ICD-10 and OPCS-4 classifications that the NHS then uses to set resource-management targets and receive reimbursement for treatment and care. Rules can be very complex and strict; it’s essential to keep up-to-date with policies and procedures. I think of myself as a detective; collecting, arranging and presenting evidence. For a history graduate, too awful at chemistry to fulfil my aspirations of becoming an ophthalmologist, it’s perfect. My coding career was an accident – a logical but ambitious step for a medical records filing clerk. |
| Coding is big business now that it’s linked to finance. I’ve just taken my national clinical coding qualification and am pending results. If I pass the very demanding (90% accuracy) test I’ll be able to use ACC (accredited clinical coder) after my name and start working towards becoming a clinical coding trainer or auditor. Colleagues tell me I’d make a great trainer so often I’m starting to believe it. | Coding is big business now that it’s linked to finance. I’ve just taken my national clinical coding qualification and am pending results. If I pass the very demanding (90% accuracy) test I’ll be able to use ACC (accredited clinical coder) after my name and start working towards becoming a clinical coding trainer or auditor. Colleagues tell me I’d make a great trainer so often I’m starting to believe it. |
| I spend the morning trawling through an epic set of case notes. The patient has had a rough time. Already in poor health, he fell over while trying to alight a train and fractured his femur. This could have been a couple of week’s admission, but, following the insertion of a dynamic hip screw, he developed post-operative pneumonia and deep vein thrombosis and ended up having vascular surgery. I try to remember there’s a real person behind the masses of disorganised paperwork. | I spend the morning trawling through an epic set of case notes. The patient has had a rough time. Already in poor health, he fell over while trying to alight a train and fractured his femur. This could have been a couple of week’s admission, but, following the insertion of a dynamic hip screw, he developed post-operative pneumonia and deep vein thrombosis and ended up having vascular surgery. I try to remember there’s a real person behind the masses of disorganised paperwork. |
| I wander outside for lunch; it’s sunny and I know if I stay sitting at my desk I’ll only end up on BBC News or Vice. I love reading, but you’ve got to have a rest. | I wander outside for lunch; it’s sunny and I know if I stay sitting at my desk I’ll only end up on BBC News or Vice. I love reading, but you’ve got to have a rest. |
| Early afternoon brings a few simple episodes – chest pain, vomiting, a bronchoscopy, and another complex case; this time poor handwriting and conflicting accounts by clinicians make it difficult to determine whether my patient has a malfunctioning tracheostomy or if it’s her artificial voice box playing up. I settle for the trachy but ask my colleague for her opinion. She disagrees and we debate for a while. I stick with my original idea but fire off an email to the discharging clinician. | Early afternoon brings a few simple episodes – chest pain, vomiting, a bronchoscopy, and another complex case; this time poor handwriting and conflicting accounts by clinicians make it difficult to determine whether my patient has a malfunctioning tracheostomy or if it’s her artificial voice box playing up. I settle for the trachy but ask my colleague for her opinion. She disagrees and we debate for a while. I stick with my original idea but fire off an email to the discharging clinician. |
| A business manager arrives and asks me what the code is for a gastrostomy insertion. I give him a few differentials. He asks which one will make the most money. “We code for information, finance is a by-product,” I tell him, pointing to a poster that makes the same point. | A business manager arrives and asks me what the code is for a gastrostomy insertion. I give him a few differentials. He asks which one will make the most money. “We code for information, finance is a by-product,” I tell him, pointing to a poster that makes the same point. |
| At 2.30pm my manager asks me to go to the mortuary to code some notes. The coroner asks if I mind walking through the fridge room. I don’t. There’s not much to see and the only smell is sawdust. I sit at a desk taking notes then return to my office and translate them into codes using my ICD-10 ‘Bible’. | At 2.30pm my manager asks me to go to the mortuary to code some notes. The coroner asks if I mind walking through the fridge room. I don’t. There’s not much to see and the only smell is sawdust. I sit at a desk taking notes then return to my office and translate them into codes using my ICD-10 ‘Bible’. |
| At 3.55pm I change my shoes and clock off. Since it’s my girlfriend’s turn to cook, when I get in I read Kerouac. | At 3.55pm I change my shoes and clock off. Since it’s my girlfriend’s turn to cook, when I get in I read Kerouac. |
| If you would like to be featured in our “Day in the life of...” series or know someone who would be great to include, email healthcare@theguardian.com | If you would like to be featured in our “Day in the life of...” series or know someone who would be great to include, email healthcare@theguardian.com |