Abstract
Background: FESS encompasses numerous component procedures including
antrostomy, ethmoidectomy, sphenoidotomy and frontal sinusotomy. The
extent of FESS procedure will vary between patients depending on
indications, imaging and surgical experience. Each procedure is
remunerated according to procedural components with each component
assigned an OPSC-4 cost code. In NHS hospitals, this relies on clinical
coders’ interpretation from the operation note, and may potentially be
subject to incorrect coding and remuneration. Background: We have
devised a FESS documentation tool which includes a tick box system for
each component and allied procedures performed, together with relevant
OPSC-4 codes.The aim of this novel FESS operation note is to improve
accuracy of coding for procedures, avoid misinterpretations and ensure
accurate remuneration for FESS procedures. Design: Retrospective quality
improvement study. Methods: The tool was implemented in our hospital in
April 2019. Codes and costs applied to each patient undergoing FESS for
a 6-month period between April to October 2019 were compared for all
cases performed during the same 6 month period in 2018. Data review of
coding information was performed between the two time periods including
T-test analysis to calculate for statistical significance. Results: 66
patients underwent FESS in 2018 compared to 70 patients in 2019, during
the equivalent 6 month period. The tool was not used in two cases in the
2019 cohort. In 2018, the average cost applied to each FESS case was
£1,676, compared to £1,953 per patient in the 6 months after the tool
was implemented. This resulted in an average uplift of £277 in revenue
per patient where the tool was used (p=0.003), due to more accurate
capture and coding of FESS component parts. On average ,approximately
140 patients undergo FESS per year in our department; using the newly
devised FESS documentation tool, we can estimate a potential increase in
revenue of £38,780 per annum for FESS procedures alone. Conclusion: Our
novel documentation tool has improved the clarity of recording
endoscopic sinus surgery allowing more accurate interpretation and
application of OPSC-4 coding. It also aids in understanding complex
composite procedures and can be extended to other surgical specialties.