Practitioner Zone

Specialists should advise their patients of the likely costs of treatment.

Procedure coding is based on the CCSD Schedule of Procedures. All invoices should be submitted using the CCSD Schedule of Procedures. Where a suitable code does not exist, please contact the Specialist Fee Team who will assist you: hcfee@aviva.co.uk or 023 8035 4609.

Fees include any pre and post-operative care and in-patient consultation. The fee also includes management of a patient in critical care where this is expected as a part of a procedure.

Guidelines

Multiple Procedures

If more than one procedure is performed we will normally pay for only the primary procedure.

Where we are satisfied that any other procedures performed do not form an integral part of the highest value procedure we will pay an additional 50% of the second and 25% of any subsequent procedure. This will also apply to those procedures which include the text 'as sole procedure'.

Simple procedures carried out at a consultation may be eligible for a modest increase in the consultation fee.

Bilateral procedures are shown as a separate code in most instances.

If you are performing a procedure which is not listed, you should contact our Provider Services Team on the number shown to discuss further.

Code Combinations

Some of the procedures listed in this schedule incorporate other procedures which appear in their own right, but are also an integral part of the main procedure. Aviva will not pay additional fees where a procedure is unbundled, that is, broken down into its separate components and then charged for as an itemised list of procedures, where such an approach leads to a higher overall charge.

Examples of unbundling are:

1. Main Procedure:
   • W8600 - Therapeutic arthroscopic operation on cavity of joint (not otherwise specified) (as sole procedure)
     This includes the lesser procedure:
   • W8700 - Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure)
     The lesser procedure should not be billed for separately.
2. Main Procedure:
   • Q0710 - Radical Hysterectomy and lymphadenectomy (Wertheim's)
     This includes the lesser procedure:
   • Q2230 - Bilateral oophorectomy and salpingectomy. (as sole procedure) (including bilateral)
     The lesser procedure should not be billed for separately.

Local Anaesthesia/IV Sedation

No additional benefit is payable for the application of local anaesthesia and/or sedation where we consider this to be an integral part of the procedure based on accepted, standard medical practice. These procedures are indicated by an * in the schedule and the published fee is the maximum payable by us, inclusive of any anaesthesia and/or sedation used.

Aviva does however recognise that ongoing changes in medical practice mean that there are a growing number of occasions when a surgeon / anaesthetist will use a local anaesthetic and/or IV sedation for a procedure where in the past, general anaesthetic will have been used. In such circumstances an additional fee of 25% of the surgical units up to a maximum of £84 will be payable.

No additional fees for anaesthesia and/or sedation will be payable by us, for those procedures where no anaesthetic value is shown and which are not indicated by an * in the fee schedule.

Assistants/Standby Fees/Treatment requiring more than one Specialist

No additional fees are payable for assistants, as assistants are considered to be employed by the specialist.

If a standby consultant (of another speciality) is to be used, written agreement to this should be requested from our Customer Service Department in advance of treatment. The clinical/medical reasons for such additional costs will be required but we will also later need written confirmation that the standby consultant was physically present during the entire procedure and had no other commitments during that time.

In those instances where a procedure requires specialists in two different disciplines to be present at the time of surgery, the lead surgeon should contact us to agree fee arrangements in advance of surgery.

Aviva will not meet the cost of multi-disciplinary case conferences.

Notes for Anaesthetists

Routine pre-operative assessment of patients is included in the anaesthetic fee shown for each procedure. Where extensive pre-operative management is required or a consultation prior to admission is necessary, we may pay additional fees. You are advised to contact us in all such instances.

Expected and planned attendance by an anaesthetist during intensive care (eg post cardiac surgery) is covered by the anaesthetic fee for the operation as it will be part of the routine post-operative management including initiation of intravenous infusion for pain relief - ie PCA.