Are re-admissions with acute exacerbation of chronic obstructive pulmonary disease coded correctly?

Background: Re-admissions are common and challenging for hospitals across the UK. They not only affect patients but also have financial implications for trusts. A hospital re-admission with the same clinical condition within 30 days of discharge incurs no payment. Acute exacerbation of chronic obstructive pulmonary disease (COPD) is well recognised as a cause of recurrent admissions. We have reviewed the re-admissions to our trust in a cohort of patients with COPD. Methods: Retrospective review of consecutive patients coded as re-admissions within 30 days with acute COPD exacerbation between September 2012 and April 2013. Electronic patient records were used to review both the index (first) admission and re-admission episodes. Results: A total of 915 patients were admitted with COPD during the 8 months. Of these, 135 were coded as re-admissions. On review of discharge diagnoses, 77 patients were coded correctly on the index admission and 115 on the re-admission episode. A total of 78 patients were incorrectly coded, 58 on the index admission and 20 on re-admission. 73 (54%) of the 135 coded re-admissions were identified as definite re-admissions. The remaining 62 (46%) were not re-admitted within 30 days of the first admission and thus incorrectly coded. Conclusion: Almost 50% of patients coded as re-admissions with acute exacerbation of COPD were inaccurate. Clinical coding needs to improve in order to minimise and avoid financial penalties.