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 Relationships Team who will assist you: firstname.lastname@example.org or 0800 015 7756.
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.
Our multiple rules are calculated as 100% of the first procedure, 50% of the second procedure and 25% of the third procedure. This does apply to Outpatient, Day Patient and Inpatient
We have recently reviewed our stance regarding billing for multiple procedures carried out during the same theatre session.
From 1st July 2012 we will no longer be remunerating for more than three procedures in one theatre session as it is felt that any more than this would be a minor addition to, or part and parcel of the main procedure being carried out. This brings Aviva in line with the rest of the private medical insurance market. Should you have any queries regarding this change please contact email@example.com
Introduction to Inappropriate Code Combinations
Some of the procedures listed in our fee schedule include other procedures that are also listed in their own right, but are an integral part of the main procedure. We will not pay additional fees where a procedure is broken down into its separate components, where such an approach results in a higher overall charge.
We continue to work with healthcare providers and CCSD (Clinical and Coding Schedule Development) group to define inappropriate code combinations and welcome feedback to inform our approach. Please contact our Specialist Relationships Team on 0800 015 7756 or email us at: firstname.lastname@example.org.
To clarify why we deem some code combinations inappropriate, we have described six scenarios below:
- Impossible - procedures which are deemed unable to be performed together or, rarely, as a sole procedure.
- Minor additional - a procedure, additional to the main procedure, where the extra time taken to perform it is deemed insignificant (in relation to the main procedure) and hence no additional fee is justified.
- Part & parcel - a procedure which is so frequently performed as part of the main procedure that it forms an integral part of it.
- Mutually exclusive - procedures which are usually precluded from being performed together or are describing different methods of performing essentially the same operation.
- Another code - another code either more accurately describes the procedure or amalgamates different components of the procedure.
- Either/Or - both codes describe the same procedure, although may be different techniques or approaches.
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.
All fees quoted under anaesthetic units only apply when general anaesthesia has been administered. Please refer to the guidance on local anaesthesia/IV sedation when not using general anaesthetic.
Invoicing for Uncoded and Complex Procedures
Use of appropriate procedure codes
As a consultant it is your responsibility to code accurately and appropriately. Should you be in any doubt of the most appropriate code please contact our specialist relationships team on 0800 015 7756 or email@example.com
Invoices must be coded using the industry standard CCSD code. If any procedure is undertaken which doesn't have a CCSD code, specialists should contact CCSD to request a new code (www.ccsd.org.uk) or contact the specialist relationships team at Aviva for more advice.
Please note we do not provide benefit for experimental or unproven procedures, including those using new technology or drugs, where safety and effectiveness have not been established or generally accepted. Please contact the specialist relationships team for more advice.
Under NO circumstances should codes intended for existing procedures be used for new and un-coded procedures. The narratives and codes are protected by copyright and may not be altered or used in any other way. The use of alternative codes for un-coded procedures could be considered as fraudulent as this is coding for procedures not performed.
The fee level we have calculated for procedures are intended to cover more complicated and time consuming operations as well as more straightforward ones. Should surgery be significantly more complex than expected, please submit a medical report prior to surgery and anaesthetic notes following surgery so we may review and obtain expert advice. This will allow us to advise our customer and you of the appropriate fee levels available.