Using service line reporting software to evaluate income and cost of hallux valgus surgery in an NHS Hospital: coding is critical!

M. Karski, A. Ajis, T. Clough

Introduction: Service line reporting (SLR) is a business intelligence software model that is a tool for evaluating a hospital’s income and expenditure. We used our trust’s SLR software to evaluate hallux valgus surgery.

Methods: We used SLR software to search for the primary procedure codes of W153 (1st metatarsal osteotomy) and W791 (soft tissue correction of hallux valgus) for two Consultants patients in 1 year (2012/2013). 51 cases were analysed.

Results: For 32 cases, the primary procedure code was W153 (1st metatarsal osteotomy). SLR showed these cases generated a mean income of £3280 (range £1955 - £4209). The mean cost per case was £1993. Mean profit per cases coded as W153 was £1,287. In 19 cases, the primary procedure was coded as W791 (soft tissue correction of hallux valgus) and in all these cases a 1st metatarsal osteotomy was also performed. The mean income was £1168 (range £1048 - £1605). Mean cost was £1829. This resulted in a mean loss of £661 per case coded as W791.

Conclusion: Cases with a primary procedure code of W791 (soft tissue correction of hallux valgus) received a mean income that was £2112 less than those cases coded as W153 (1st metatarsal osteotomy). The W153 code generates an “intermediate foot procedure” HRG tariff for the majority of cases, compared to a “minor foot procedure HRG tariff” for W791. This has resulted in an estimated £40,128 loss of income to our hospital for the 19 cases identified. The soft tissue correction is coded as the primary procedure code, even if a metatarsal osteotomy is also recorded, as per the national NHS coding rules, which specifically state that the W791 code must be used as the primary procedure code. National coding guidelines may need to be changed to address this issue.