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Clinical coding improving payment by results in breast surgery
664
ABSTRACTS
results of ultrasound and FNAC/biopsy was high at 13% and therefore, remains an inadequate definitive predictor of axillary node involvement. http://dx.doi.org/10.1016/j.ejso.2014.02.183 P185. B3 pathologies and malignancy e Which are the risk lesions? Caroline Strachan, Abeer Shaaban, Kieran Horgan, Nisha Sharma St James University Hospital, Leeds, UK Introduction: The term B3 comprises a heterogeneous group of pathologies with varying malignant potentials. Some subsets of this group (e.g. AIDP), have reported malignancy rates at surgical excision of 30-40%. Other subsets (e.g. LCIS) have comparably lower surgical rates of malignancy. Optimum management of this pathological group remains unclear. Open excision is regarded as the gold standard for definitive diagnosis, however Vacuum Assisted biopsy (VAB), with larger volume sampling, is an emerging viable alternative. Here, we review B3 pathologies in a screening population to assess and compare the predictive value of malignancy from core biopsy, and VAB, against surgery. Methodology: A retrospective database analysis was undertaken, of B3 lesions on initial core biopsy in our screening population who underwent 2nd line VAB. Results: Pathological diagnoses and upgrade rates to malignancy by VAB / open surgery of original core biopsy are depicted in the table below. 366 patients were identified, with B3 on core biopsy. 294 went on to have VAB, of those, 73 subsequently had surgical excision. AIDP was upgraded in 46% from B3 to B5a / B5b diagnosis from core biopsy. FEA shows a 15% upgrade and ALH / LCIS show 16% upgrade. Papillomas without atypia on core biopsy were upgraded in 7.6%, but if atypia was present, one third were malignant. Conclusion: AIDP on core biopsy is a risk factor for malignancy. With established predictive values for malignancy in B3 lesions from large volume biopsy such as VAB, the MDT may be guided to determine definitive management of this difficult pathological entity.
Core Pathology
Patient Numbers
% Malignant on VAB
FEA DEA+AIDP AIDP ALH/LCIS Pap+atypia Pap no atypia Rs+atypia RS no atypia other
55 38 40 30 3 52 1 27 30
15% 16% 40% 6% 33% 8% 0 0 7%
% Malignant at Surgery 3% 6% 10.% 3% 33% 4%
http://dx.doi.org/10.1016/j.ejso.2014.02.184
P186. Results following a benign breast biopsy e A breast care nurse led “virtual” telephone clinic Joanna Rowley, Gazalla Safdar, Gill Clayton, Kathryn Taylor Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Introduction: A percentage of core biopsies are performed in the one stop clinic knowing the histology will almost definitely be benign. As this accounts for up to 16% of lesions sampled in our centre, we wanted to relieve capacity in clinic, improve the patient pathway and reduce patient waiting times by introducing a telephone results clinic for benign results. We report on our 6 month experience of this new “virtual” clinic. Methods: Patients presenting with a benign clinical examination and imaging and undergoing core biopsy were offered telephone results.
Exclusion criteria included a positive family history, hearing impairment or learning difficulties. All patients were seen by a Breast Care Nurse, accepted a date and time for the telephone call and were given the relevant written information. The new protocol included a caveat to revert to a clinic appointment should the biopsy results not be benign. Results: From 1/6/2013 to 1/12/2013, 50 patients met the criteria for telephone results. 49 had confirmed benign (B2) pathology of which only 1 was not available at the time of telephone contact and was informed of her result by letter. 1 patient had a normal (B1) result and required a clinic appointment for review. She was subsequently discharged. Conclusions: Our experience has shown that a telephone results clinic is appropriate when protocols for biopsy are followed. A prospective review of patient satisfaction is being undertaken to further evaluate this service. http://dx.doi.org/10.1016/j.ejso.2014.02.185
P187. Clinical coding improving payment by results in breast surgery Werbena Hamilton-Burke, Rajani Gurung, Matthew Parry, Lee Martin Aintree University Hospital, Liverpool, UK Background: The Audit Commission’s Payment by Results data assurance framework found significant levels of error at both the clinical coding and the Healthcare Resource Group levels. The most common factor found to contribute to errors was the quality of the source documentation. This included illegible or poorly structured case notes and insufficient information included on patient records. In August 2013 a new operation sheet was implemented in the Breast Surgical Unit at Aintree Hospital. This operation sheet included a range of operations with its codes. It also has a range of co-morbidities available to be marked by the surgeon when applicable. Aim: This project aimed to identify improvement in clinical coding in breast surgery including surgical procedures and co-morbidities and to identify potential sources of error on clinical coding. Methods: All operations performed between 1/08/2013 and 31/10/ 2013 were analysed. The new operating proforma was analysed against the clinical coding. Accuracy of clinical coding and compliance with the proforma was assessed. Results: Sixty case notes were analysed. Three (5%) coding comorbidity errors and 2 (3%) OPCS recording errors were found. Those were mainly due to omission of diagnosis and procedures. Only one was due to overestimation of the procedure. There was an improved accuracy of coding compared with results from the same period on the previous year when the operation sheet proforma was not in use. The errors were reduced by approximately 50% and did not have a financial impact on HRG. Conclusion: Implementation of the new operation sheet improved the efficiency of clinical coding and reduced the risk of inaccurate clinical coding. There was a greater accuracy in the payment by results with a clear financial benefit to the Trust. The financial benefits to the Trust include not only greater accuracy in PbR returns but better returns for the investment in the clinical coding department. http://dx.doi.org/10.1016/j.ejso.2014.02.186
P188. Learning curve associated with immediate Strattice based implant reconstruction Chris Holcombe, Karen Little, Ian Quayle, Mysore Chandrashekar, Geraldine Mitchell, Anne Tansley Royal Liverpool University Hospital, Liverpool, UK Introduction: There have been variable accounts of the complication rate associated with Strattice based reconstruction. In Liverpool with the introduction of Strattice for immediate implant based reconstruction we have seen a clear ‘learning curve’ demonstrated amongst the 4 experienced reconstructing surgeons.
ABSTRACTS
results of ultrasound and FNAC/biopsy was high at 13% and therefore, remains an inadequate definitive predictor of axillary node involvement. http://dx.doi.org/10.1016/j.ejso.2014.02.183 P185. B3 pathologies and malignancy e Which are the risk lesions? Caroline Strachan, Abeer Shaaban, Kieran Horgan, Nisha Sharma St James University Hospital, Leeds, UK Introduction: The term B3 comprises a heterogeneous group of pathologies with varying malignant potentials. Some subsets of this group (e.g. AIDP), have reported malignancy rates at surgical excision of 30-40%. Other subsets (e.g. LCIS) have comparably lower surgical rates of malignancy. Optimum management of this pathological group remains unclear. Open excision is regarded as the gold standard for definitive diagnosis, however Vacuum Assisted biopsy (VAB), with larger volume sampling, is an emerging viable alternative. Here, we review B3 pathologies in a screening population to assess and compare the predictive value of malignancy from core biopsy, and VAB, against surgery. Methodology: A retrospective database analysis was undertaken, of B3 lesions on initial core biopsy in our screening population who underwent 2nd line VAB. Results: Pathological diagnoses and upgrade rates to malignancy by VAB / open surgery of original core biopsy are depicted in the table below. 366 patients were identified, with B3 on core biopsy. 294 went on to have VAB, of those, 73 subsequently had surgical excision. AIDP was upgraded in 46% from B3 to B5a / B5b diagnosis from core biopsy. FEA shows a 15% upgrade and ALH / LCIS show 16% upgrade. Papillomas without atypia on core biopsy were upgraded in 7.6%, but if atypia was present, one third were malignant. Conclusion: AIDP on core biopsy is a risk factor for malignancy. With established predictive values for malignancy in B3 lesions from large volume biopsy such as VAB, the MDT may be guided to determine definitive management of this difficult pathological entity.
Core Pathology
Patient Numbers
% Malignant on VAB
FEA DEA+AIDP AIDP ALH/LCIS Pap+atypia Pap no atypia Rs+atypia RS no atypia other
55 38 40 30 3 52 1 27 30
15% 16% 40% 6% 33% 8% 0 0 7%
% Malignant at Surgery 3% 6% 10.% 3% 33% 4%
http://dx.doi.org/10.1016/j.ejso.2014.02.184
P186. Results following a benign breast biopsy e A breast care nurse led “virtual” telephone clinic Joanna Rowley, Gazalla Safdar, Gill Clayton, Kathryn Taylor Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Introduction: A percentage of core biopsies are performed in the one stop clinic knowing the histology will almost definitely be benign. As this accounts for up to 16% of lesions sampled in our centre, we wanted to relieve capacity in clinic, improve the patient pathway and reduce patient waiting times by introducing a telephone results clinic for benign results. We report on our 6 month experience of this new “virtual” clinic. Methods: Patients presenting with a benign clinical examination and imaging and undergoing core biopsy were offered telephone results.
Exclusion criteria included a positive family history, hearing impairment or learning difficulties. All patients were seen by a Breast Care Nurse, accepted a date and time for the telephone call and were given the relevant written information. The new protocol included a caveat to revert to a clinic appointment should the biopsy results not be benign. Results: From 1/6/2013 to 1/12/2013, 50 patients met the criteria for telephone results. 49 had confirmed benign (B2) pathology of which only 1 was not available at the time of telephone contact and was informed of her result by letter. 1 patient had a normal (B1) result and required a clinic appointment for review. She was subsequently discharged. Conclusions: Our experience has shown that a telephone results clinic is appropriate when protocols for biopsy are followed. A prospective review of patient satisfaction is being undertaken to further evaluate this service. http://dx.doi.org/10.1016/j.ejso.2014.02.185
P187. Clinical coding improving payment by results in breast surgery Werbena Hamilton-Burke, Rajani Gurung, Matthew Parry, Lee Martin Aintree University Hospital, Liverpool, UK Background: The Audit Commission’s Payment by Results data assurance framework found significant levels of error at both the clinical coding and the Healthcare Resource Group levels. The most common factor found to contribute to errors was the quality of the source documentation. This included illegible or poorly structured case notes and insufficient information included on patient records. In August 2013 a new operation sheet was implemented in the Breast Surgical Unit at Aintree Hospital. This operation sheet included a range of operations with its codes. It also has a range of co-morbidities available to be marked by the surgeon when applicable. Aim: This project aimed to identify improvement in clinical coding in breast surgery including surgical procedures and co-morbidities and to identify potential sources of error on clinical coding. Methods: All operations performed between 1/08/2013 and 31/10/ 2013 were analysed. The new operating proforma was analysed against the clinical coding. Accuracy of clinical coding and compliance with the proforma was assessed. Results: Sixty case notes were analysed. Three (5%) coding comorbidity errors and 2 (3%) OPCS recording errors were found. Those were mainly due to omission of diagnosis and procedures. Only one was due to overestimation of the procedure. There was an improved accuracy of coding compared with results from the same period on the previous year when the operation sheet proforma was not in use. The errors were reduced by approximately 50% and did not have a financial impact on HRG. Conclusion: Implementation of the new operation sheet improved the efficiency of clinical coding and reduced the risk of inaccurate clinical coding. There was a greater accuracy in the payment by results with a clear financial benefit to the Trust. The financial benefits to the Trust include not only greater accuracy in PbR returns but better returns for the investment in the clinical coding department. http://dx.doi.org/10.1016/j.ejso.2014.02.186
P188. Learning curve associated with immediate Strattice based implant reconstruction Chris Holcombe, Karen Little, Ian Quayle, Mysore Chandrashekar, Geraldine Mitchell, Anne Tansley Royal Liverpool University Hospital, Liverpool, UK Introduction: There have been variable accounts of the complication rate associated with Strattice based reconstruction. In Liverpool with the introduction of Strattice for immediate implant based reconstruction we have seen a clear ‘learning curve’ demonstrated amongst the 4 experienced reconstructing surgeons.