Clinical scoring and surgeous: what should be coded, and why?

The clinical coding system recently instituted in France, the PMSI (Projet de Medicalisation du Systeme d'Information), has become an unavoidable elem ent in funding allocations for short-term private and pubic hospitalization centers. Surgeons must take into serious consideration this controversial medicoeconomic instrument. Coding is a dire time-consuming task but, like t he hospitalization or surgery report, is an essential part of the discharge procedure. Coding can in the long run be used to establish pricing by path ology. Surgeons should learn the rules and the logic behind this coding sys tem: which, not being based on a medical rationale, may be somewhat difficu lt to understand. Choosing the right main diagnosis and the comobidity Item s is crucial. Quality homogeneous coding is essential if one expects the he alth authorities to make good use of the system. Our medical societies have a role to play in promoting and harmonizing the coding technique.