Another question asked at the recent Medical Defence Union presentation.
Insurance companies use medical coding to identify and detail a medical procedure.
For example, an Orthopaedic surgeon will understand what a Multiple arthroscopic operation on the knee is. But that is an awful lot to put on an invoice every time. Plus there may be variations on such an episode.
It’s better to put the code W8500 on the invoice which 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. Aviva, AXA-PPP, BUPA, Vitality and Simply Health. 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, a CCSD does not publish a suggested rate of remuneration.
The rate payable for each code is up to the individual insurance company concerned. As a result, the surgeon has to check with the patient’s insurance company.
A CCSD code is imperative IF a surgical episode is required. The patient will need to quote the code to his or her insurance company when pre-authorisation is being requested anyway.
Thus when an invoice is sent to the insurance company for your fees, 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