Show Me The Money: Coding at St.Emlyn’s

coding stemylns podcast

Have you ever wondered how it is that your hospital gets paid for the work you do? Perhaps you think that this isn’t relevant to you? Well, in this podcast we discuss how hospitals in England are remunerated for the patients they see in there EDs and why we, as clinicians, should do everything we can to ensure the clinical coding recording the details of the patient’s visit is correct.

Hospitals in England are paid on a “payment by results” basis. In essence, the more you do for a patient the more they are paid (up to a maximum of £237). This is done via “HRG4” codes that add together investigations and treatment, to give a code that equates to how much that episode is worth, with eleven different codes available.

HRG Code Table

It’s important to remember that the hospital is paid this fee for any patient who attends the ED whether they are admitted or discharged (there is a further set of complicated codes to work out cost for inpatient hospital stays).

This data isn’t just used for costing purposes, but also regularly quoted when looking at patients who attend for whom “nothing is done” in the group VB11Z, so accuracy is vital and we hope this podcast will help encourage you to take just a little extra time to ensure your data entry and discharge information is as complete as possible.






Addendum: The post has received a lot of interest, most notably from Cliff Mann himself who reminds us that the college has put tariffs and payment systems as a very high priority.

Don’t forget the CEM10

D__websites_Medicine_collemergencymed2014_Upload_documentz_CEM7878-10 priorities for resolving the A&E crisis (External v8 04 11 2013)

Cite this article as: Iain Beardsell, "Show Me The Money: Coding at St.Emlyn’s," in St.Emlyn's, October 30, 2014,

4 thoughts on “Show Me The Money: Coding at St.Emlyn’s”

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  2. It’s probably worth noting a couple of things about the A&E tariff:

    Payment by Results is a pretty blunt instrument which is really designed for funding hospitals, not individual departments or patients. Although, increasingly we are seeing it being used for this purpose.

    The tariffs are actually set based on the costs which are submitted by Trusts. The average costs submitted for each HRG are the basis of the tariff (although there are a number of adjustments made afterwards). In theory though, about 50% of patients should be ‘profitable’

    The key thing to know about the A&E tariff, is that it does not include all the costs associated with the patients time in the ED. The costs associated with the admission into hospital are actually included in the inpatient tariff. A proportion of the income generated by the (non-elective) admitting specialities is therefore for the patient’s time in the ED (although these specialities are also incurring costs in the ED, by sending the RMO, for example).

    So, how are the costs associated with admission calculated? Well, for each HRG, you take the total costs reported for discharged patients away from total costs reported for admitted patients, and those costs are then apportioned to the inpatient tariffs.

    The tariff the ED will receive is based on the reported costs for patients who are not admitted (regardless of whether not the patient is admitted). The £235 maximum tariff is therefore only based on patients who are coded as having CPR/resuscitation, but then not admitted, and isn’t designed to cover all the costs for admitted patients.

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Thanks so much for following. Viva la #FOAMed

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