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BMJ Open Qual. 2020 Mar;9(1). pii: e000723. doi: 10.1136/bmjoq-2019-000723.

Improving the quality of clinical coding and payments through student doctor-coder collaboration in a tertiary haematology department.

Author information

School of Medical Education, King's College London, London, UK
School of Medical Education, King's College London, London, UK.
Clinical Coding Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
Contributed equally


Hospitals within the UK are paid for services provided by 'Payment-by-Results'. In a system that rewards productivity, effective collaboration between coders and clinicians is crucial. However, clinical coding is frequently error prone and has been shown to impact negatively on departmental revenue. Our aim was to increase the median number of diagnostic codes per sickle cell inpatient admission at Guy's Hospital by 3. Three interventions were implemented using the Plan, Do, Study, Act structure. This consisted of student doctors searching for diagnoses along with comorbidities that clinical coders had missed, distributing laminated cards with common clinical codes and implementing discharge pro formas. Through auditing, student doctors generated a total of £58 813 over 16 weeks. We observed an increase in the median number of codes by ≥2 additional codes. We improved coding accuracy where we identified errors in an average of 32.5% of admissions each month, improving the quality of patient documentation. We have demonstrated student doctor involvement in clinical coding as a potentially sustainable means of achieving accurate payment for services provided; increasing departmental revenue. We are the first to report the efficacy of student-coder collaboration in improving the accuracy of clinical coding.


PDSA; cost-effectiveness; medical education; quality improvement; teamwork

Conflict of interest statement

Competing interests: None declared.

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