A Note on Clinical Coding – On Behalf of the BSG IPC

Members in private practice will be aware of the need to accurately assign procedure codes when they submit invoices for payment to private medical insurers in the UK.

These codes were originally developed by BUPA, and were loosely based on NHS codes though their purpose was simply to help with reimbursement arrangements. Codes used by the NHS focused on activity and epidemiology rather than financial flows though with the development of Payment By Results and 'tariff', NHS coding needs are changing.

Several private medical insurers are now working together to maintain and develop a consistent coding schedule. They work together as the Clinical Coding Schedule Development (CCSD) group. They respond to developments in clinical practice by assigning new codes where existing codes cannot capture the complexity of a new procedure. The group does not dictate fee levels, decisions about which remain with the individual insurers. Although some private medical insurers are not members of CCSD, they all make use of the group's output. The codes may be built into commercially-produced private practice management software too.

CCSD produces a monthly coding update bulletin. Private medical insurers are likely to update their online schedules to reflect code changes. They may write to consultant providers outlining important changes too. Commercial private practice management software providers include new codes when they upgrade their software.

To help members, the BSG IPC is arranging to receive CCSD's monthly bulletin and will post on the website, any new codes that appear relevant to our practice. Individual consultants are welcome to register with the new website to access the full schedule, receive updates and submit requests for new codes too.

Tim Heymann, Chair BSG Information Group