Another question asked at a recent presentation.
Insurance companies use medical coding to identify a medical procedure.
For example, an Orthopaedic surgeon understands what a Multiple arthroscopic operation is. But that is a lot to put on an invoice. Rather put the code W8500 on the invoice. That will specifically identify the episode.
So where do you find the code?
Most codes can be located on the CCSD website: www.ccsd.org.uk
The Clinical Coding and Schedule Development Group (CCSD) consists of the five major healthcare insurers. Its purpose is to maintain a common standard of procedure codes. Consequently, CCSD publishes a Schedule of codes which reflect current medical practice.
Where do you find the fee?
However, be warned. Whilst the example above of W8500 will be recognized, CCSD does not publish a suggested fee. The rate payable for each code is up to the individual insurance companies. As a result, the surgeon has to check with each one.
A CCSD code is imperative IF a surgical episode is required. The patient will need to quote the code to his insurance company when pre-authorisation is being requested anyway.
Thus when an invoice is sent to the insurance company, the code should appear on the invoice. It will reconcile to that expected by the insurance company.
If alternatively, you do NOT use CCSD codes payment will be substantially delayed if made at all!
pete@medicalhealthcaremanagement.co.uk