By Dr Thaleia Kalatha, Senior Clinical Fellow, Salford Royal NHS Foundation Trust

MS Intermediate MasterClass 8, 2019



Patients with multiple sclerosis may experience different disease courses with significant variation in symptoms, degree of disability and care needs. Comordidities may also influence symptoms and increase risk of complications- treatment related or not. Care of complex patients with multiple sclerosis needs can be associated with prolonged hospital stay.

A study of comorbidities according to clinical coding was undertaken to address the variability of clinical problems in day cases of patients with multiple sclerosis in Salford Royal Foundation Trust. Clinical coding is the translation of medical terminology, as written by the clinician to describe a patient’s complaint problem, diagnosis, treatment or reason for seeking medical attention, into a coded format which is nationally and internationally recognized to support both statistical and clinical uses. Trust income is totally dependent upon the ability of the team to accurately code within time constrains.

Coding of the comorbid condition in day case patients with MS treated with natalizumab changed tariff from basic £169/day to £246/day when clinical coding score of comorbidities was from 2-4 and to £849/day when clinical coding score was 4-8. Higher scores changed the tariff to £2902/day when clinical coding score was more than 8. The percentage of change in day case tariffs varied between 45.6-1617%/month. The cumulative amount, per person, due to change in coding varied from £154-£21928 depending on the months that the change had been applied.

Better coding promotes better care as hospital care is more adequately funded in order to tackle all possible needs. The translation of this in nursing requirements, team structure and staff support may enable better planning for the service. Accurate and complete information of comorbidities underpins delivery of safe and effective patient care.

Comparison with national data revealed differences in coding in Salford Royal Foundation Trust in comparison with other Trusts. The project would also enable comparisons with other regional services with a view for identification for reasons of variation and potential improvement by addressing them. Audit can improve clinical coding with the cooperation of clinicians and clinical coding teams for wider benefit to patients.