CCSD is pleased to launch the new classification for Diagnostic Tests to be applied across the Independent Sector. The Schedule has been developed as an industry-wide initiative driven by CCSD following a request by the ABI and its members for a more transparent and standardised mechanism for the coding and reimbursement of diagnostic tests.
The launch of the Schedule is timely and consistent with the recently published Provisional Findings from the Competition Commission’s Investigation into the Private Healthcare Market. It will help further to drive transparency, consistency and comparability across the sector.
The new schedule is largely based on NHS codes to ensure comparability with the public sector, creating the most current, relevant and comprehensive classification of such services available today.
The first release of the schedule will cover the following specialty chapters:
- Pathology; and
- Miscellaneous diagnostics.
A second release of the schedule planned for the end of year will expand the code set to cover Radiology. The ISC codes are to be used for charges relating to diagnostic tests delivered by the provider and are not to be used as CCSD procedure codes.
A draft Schedule of the first release was subject to consultation with key stakeholders in June 2013. The first release of the ISC Schedule reflects the comprehensive feedback and review from the consultation process.
Any questions around the development of the codes should be sent to CCSD.
While insurers and providers alike are welcome to adopt this new classification in its current format, CCSD recognises that most organisations across the sector will seek to preserve their existing charge codes and as such have appointed Healthcode to manage the implementation in a way that optimises up-take while minimising operational disruption for those organisations. Healthcode will map all charge codes (both insurers and providers) to the new ISC codes which will allow them to continue to use their existing charge codes.
All members of the CCSD Group are committed to working with providers to align their contracts in the long term to this new industry standard. The implementation of the ISC codes for contracting will depend on individual insurer and provider agreements. Any queries relating to the implementation of codes for contracting purposes should be directed at the relevant insurer.
Once the ISC Schedule is launched, new diagnostic code requests or amendments can be raised via the CCSD website. These will be reviewed and approved through the same process as for the procedure codes, ensuring the ISC schedule is therefore continuously developed and maintained to meet industry needs.
Healthcode will ensure the mapping is kept up to date for reimbursement purposes and therefore any queries regarding the mapping or charging of codes via Healthcode should be directed to Healthcode or the relevant insurer.
Should the diagnostic codes be loaded (and hence billed) alongside existing CCSD procedure codes?
No, these codes present diagnostic service charges and although issued by CCSD do not constitute procedures. The CCSD Schedule of Procedure codes are those you load, and will continue to, into your procedure code table(s). These Schedule of Diagnostic Test codes will be mapped to Charge Master codes as per existing ISC codes.
Will the diagnostic codes be included within the contracts between insurers and providers?
That is a matter between individual insurers and providers however the expectation is that this classification will determine the contracted service reference for Diagnostic tests going forward.
Are providers expected to replace their Chargemaster codes with these new proposed diagnostic codes?
No. While in a perfect world all parties will use a uniform and unambiguous set of codes for all business transactions we understand the practical realities are very different. As such we would expect to map provider’s Chargemaster codes to ‘new’ ISCs in the current practice.
Are insurers expected to replace their internal system codes with these new proposed diagnostic codes?
No. As above, insurers specify the grouping and hence output they wish to receive from Healthcode and that principle will be maintained. Naturally should an insurer wish to replace its existing codes it will be able to do so, but this is not a prerequisite for their deployment. Nor is this a requirement to provide validation or price screening at the granular level.
Do the diagnostic codes replace Healthcode Industry Standard codes?
No. The numbering and coding system presented within the schedules are not deployable in a systemised manner. Healthcode will therefore map the CCSD schedule codes to ISCs. This may require creation of new ISCs or renaming of existing ones and, where this is the case, Healthcode will create and amend within the ISC schedule.
Will existing Healthcode ISCs not in the CCSD schedule be retired?
Not necessarily. Where a CCSD code supersedes an existing ISC the ISC will most likely be retired. Where an ISC needs to exist beyond the insured world (i.e. the code may be required by hospitals for non-insured work) it will be retained. It is important not to confuse the existence of a code on the schedule with its acceptability on a PMI invoice.
When will the new diagnostic codes be introduced?
The codes are now effective immediately and any new code mappings undertaken by Healthcode will take them into account. Individual insurers and providers will introduce them to their own schedules but it is intended major insurers and providers will commence deployment this year (2013).
What do I need to do now?
Nothing regarding the deployment. Healthcode will work with CCSD member organisations initially to ensure their existing Industry Standard Code mappings and the relationships with the new ISC codes are understood and accepted and then agree with them how and when they should be introduced with providers.
Who will decide and drive the deployment schedule?
Individual insurers will engage Healthcode and individual providers to ensure the ‘end-to-end’ mapping from the provider’s Chargemaster to the code received by the Insurer is in line with each organisation’s expectations. As there is a single, common, Chargemaster mapping of codes between providers and Healthcode ISCs, the first insurer to be deployed for any given hospital provider will require a substantially larger effort than subsequent deployments.
Further questions on the ISC diagnostic tests not addressed above should be directed as follows:
Private Healthcare Market Investigation: Provisional Findings – The Competition Commission August 2013