Another question asked at the recent Medical Defence Union presentation.
Insurance companies use medical coding to identify and detail a medical procedure. For example: if you are an Orthopaedic surgeon you will understand precisely what a Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) is. But that is an awful lot to put on an invoice every time you produce one! Plus there may be variations on such an episode. Instead 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 representatives from the five major healthcare insurers – Aviva, AXA-PPP, BUPA, Vitality and Simply Health. Its main purpose is to maintain a common standard of procedure codes that reflect current medical practice within the independent healthcare sector by publishing a CCSD Schedule of codes.
By far therefore the various insurance companies recognize the majority of codes.
However, be warned. Whilst the example above of W8500 will be recognized, a CCSD code does not come with a fixed or even suggested rate of remuneration. The rate payable for each code is absolutely up to the individual insurance company concerned.
Whilst not so important for initial consultations, 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 and will reconcile to that expected by the insurance company.
If a private consultant surgeon does not identify the codes relevant to the procedure he or she has performed, the chances are that it will be impossible to generate an invoice to the patient’s insurance company.
pete@medicalhealthcaremanagement.co.uk