Single codes and as sole procedure codes

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Single Codes 'are the norm'

All CCSD Schedule users should use a single CCSD code to describe the majority of common clinical interventions. This single code will usually fully describe the procedure from start to finish. 

The code covers the actual procedure itself and all its component parts and additional procedures, which are routinely or commonly performed with it, for example:

  • pre-operative assessment
  • anaesthesia
  • intra-operative care
  • post-operative care
  • intensive care
  • wound dressing and care
  • immediate post operative analgesia (e.g. simple nerve blocks, local anaesthetic infiltration, local anaesthesia to joint spaces)

As sole procedure codes

All CCSD Schedule users should attempt use a single CCSD code to describe the majority of common clinical interventions which will usually fully describe the procedure from start to finish. In some instances it may be appropriate to use additional codes but you should check for any unacceptable combinations (rules which define when two codes should not be used together).

If a code has ‘as sole procedure’ in its narrative it means that it should not be coded in addition to another procedure. This will normally be because the procedure would only ever be performed in isolation or would ordinarily be part and parcel of another procedure unless performed on its own.

For example, W3100 Bone graft (as sole procedure) – this may be part and parcel of another procedure and therefore would not require a separate code unless being performed on it’s own.

It does not mean that two procedures cannot be performed together, which is a clinical matter, but that the code should only ever be used by itself. Where procedures are carried out on completely different anatomical sites, these rules may not apply and you should contact the relevant insurer for further advice.