The Health and Social Care Act 2012 sets out the national tariff for NHS healthcare services provided and those which a national price is payable. These healthcare services are specified and agreed between NHS England and NHS Improvement (previously known as Monitor) each year.
The national tariff includes rules for determining the ‘currency' (unit of healthcare) for services and relies on patient-level data to operate effectively. This information is used by a Healthcare Resource Grouper known as HRG4+ for setting national prices for admitted patient care, outpatient procedures and accident and emergency (A&E) attendances. 2014/15 HRG reference costs were used to inform the National Payment Tariff System (NPTS) for 2017-19.
· National Prices and Tariff workbook
· 2017/18 and 2018/19 National Tariff Payment System (guidance)
For outpatient attendances, the currency used is based on attendance type and clinic type, defined by a treatment function code (TFC) for the majority of specialties. Admitted patients relies largely on two standard classifications, (ICD-10) for diagnoses and (OPCS-4) for operations, procedures and interventions to be recorded.
The healthcare resource group HRG4+ system uses clinical information collected from these services to classify patients to case mix groups. This grouping is done using grouper software produced by NHS Digital HRG4+ 2017/18 Local Payment Grouper and User Manual v1.2.
HRGs are identified by a five-character code structure with the first alphabetical character (J) representing the HRG Chapter. The first two alphabetical characters together (JC) represent the HRG Subchapter. The next two numeric characters (NN) represent the HRG Number within the chapter (JC 46). The final alphabetical character (Z) signifies the Split applicable to the episode.
HRG subchapter JD covers all skin disorders in adults. It includes activity undertaken in an inpatient and day case setting. All diagnosis-driven activity relating to the treatment of children (aged 18 years and under) groups to an HRG in Subchapter PA, Paediatric Medicine, in line with the requirements of the Casemix Design Framework.
Other HRG subchapters may also provide a higher tariff for site specific operations, procedures and interventions. For e.g. CA16Z Excision or Biopsy, of Lesion of External Nose – OPCS codes E101, E091, E092, E094, E095 provides a tariff of £147 in outpatients. Comparatively JC43A for the same procedures is £113 for 13yrs and over and £120 for 12 years and under. The day case activity tariff under JC43A however does pay a higher tariff than CA16Z.
The HRG4+Code to Group spreadsheet contains a list of the chapters and subchapters relevant to an individual Casemix grouper. It includes a list of all ICD10 an OPCS codes mapped to the relevant HRG subchapter.
The main OPCS codes for dermatology services are associated with OPCS Chapter S – Skin, Breast and Burns and subchapter Skin Surgery (S01 – S70) and Chapter U - Diagnostic Imaging, Testing and Rehabilitation and subchapter diagnostic application tests on skin (U01-U54). Chapter Z – Subsidiary Classification Sites of Operation (Z01-Z99) provides site codes to be used alongside the primary chapter code where the procedure site is not specific. However other OPCS Chapters such as ‘D – Ear and subchapter Extirpation of lesion of external ear (D01-D08) should also be used when a site-specific procedure is relevant. Please note: repatriation costs back to dermatology budgets are necessary when using other site-specific specialty codes.
For a glossary of terms relating to NHS Tariffs, please refer to the NHS Improvement website - https://improvement.nhs.uk/uploads/documents/2017-2019_national_tariff_payment_system_glossary.pdf