I’ve been asked to revisit why coding is such an integral part of medical invoicing.
It is, in fact, very, very important because without the correct code the chances of a private consultant surgeon getting paid decrease dramatically. Indeed it is extremely unlikely if you wish to invoice electronically you will be able to invoice without a code.
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 is (including meniscectomy, chondroplasty, drilling or micro fracture). 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 and that will specifically identify the surgery you have undertaken.
As mentioned earlier if you are planning to invoice electronically you simply won’t be able to input the whole description anyway.
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, Simply Health and Vitality 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 them as the CCSD Schedule of codes.
The various insurance companies will therefore recognise the majority of codes.
However, a word of caution.
Whilst the example above of W8500 will be recognised, 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. To find the correct fee for the correct code for a specific insurance company, you will need to check with that insurance company. For example: the W8500 mentioned earlier carries a fee of £615 for one insurance company but only £550 for a different private medical insurance company. If you charge £550 instead of £615 by mistake, you will NOT have your fee increased to the higher level. If however you charge £615 when it should be £550, your fee will however be reduced.
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 alternatively you do NOT use CCSD codes payment will be substantially delayed if made at all!