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Aims: Reliable coding will become increasingly important with publication of individual surgeon's outcomes and 'Payment by Results'. This study examines the accuracy of operative codes when logged by coding clerks alone compared to coding with assistance from the operating surgeon, and assesses the financial implications of incomplete coding. Methods: Two consecutive 3-month periods were studied. In Period 1, codes were entered as normal by clinical coders. In Period 2, codes were logged in the patients' notes by the operating surgeon at operation and entered by coders. Missing codes were allocated a cost based on HRG estimates for 'Payment by Results'. Statistical analysis was by Chi-squared. Results: During Period 1, 96 major vascular cases were undertaken compared to 77 in Period 2. The proportion of correct codes rose from 38/96 (39%) in Period 1 to 50/77 (65%) in Period 2 (P < 0•001). Incorrect codes fell from 22/96 (23%) in Period 1 to 8/77 (10%) in Period 2 (P < 0•05). Codes were missing in 36/96 (38%) in Period 1 versus 19/77 (25%) in Period 2 (P = NS). The cost of missing operation codes under 'Payment by Results' was approximately £90, 000 in Period 1 and £60, 000 in Period 2. Conclusions: Surgeon input improves coding accuracy by reducing incorrect codes but has no significant effect on missing codes. The current coding system will cost the department approximately £360 000 pa from missing codes once 'Payment by Results' is fully implemented. Surgeon recording of codes at operation
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