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Bupa Schedule of Procedures

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					         Bupa Policy Notes



Bupa Schedule of Procedures


Uplifts of Benefit

Bupa keeps the PMI market under constant review and following recent research and in response
to feedback that we have received from consultants we have uplifted the surgical benefit of 8
procedures.
These codes are:


                                                                                       Current Bupa    Revised Bupa
             Procedure                      Procedure Narrative
                                                                                       Benefit Limit   Benefit Limit


  Surgical               Discogram/Diagnostic intervertebral disc injection under X-
              V5230                                                                       £167            £249
    Fee                                         ray control
  Surgical
              65050                             Discography                               £167            £249
    Fee
  Surgical
              H3322              Laparoscopic abdominoperineal resection                 £1,370          £1,725
    Fee
  Surgical
              H3320           Abdominoperineal resection of rectum and anus              £1,370          £1,725
    Fee
  Surgical
             W3719         Metal on Metal Hip Replacement Arthroplasty Bilateral         £1,370          £1,725
    Fee
  Surgical
             W3718                   Minimally invasive hip resurfacing                   £837           £1,040
    Fee
  Surgical                    Bilateral autograft for anterior cruciate ligament
             W7421                                                                        £716           £1,370
    Fee                              reconstruction as a sole procedure
  Surgical
              K6015               Implantation of bi-ventricular pacemaker                £619           £1,040
    Fee




Edition 4
Date June 2010
Schedule amendments and changes

The latest version of the Bupa Schedule of Procedures can be found at www.consultantnet.org.
The schedule is updated each time a new code is added or changed.

Over the next few weeks we will be introducing more than 100 new CCSD codes into the Bupa
Schedule of Procedure. Because of this we advise consultants not to print off copies as they will
quickly become outdated.

Coding Principles (previously known as Unbundling)

From September this year, Bupa will be adopting the CCSD coding principles (unbundling) table.
All CCSD schedule users should use a single CCSD code to describe the majority of common
clinical interventions. This single code fully describes the procedure from start to finish. The code
covers the actual operation itself and all component parts and additional procedures, which are
routinely or commonly performed with the operation. For example:

      Pre-operative assessment
      Anaesthesia
      Intra-operative care
      Post-operative care
      Intensive care
      Wound dressing and care
      Immediate post operative analgesia (e.g. nerve blocks, local anaesthetic infiltrations, local
       anaesthesia to joint spaces

No common clinical intervention should routinely require more than one code but occasionally,
two procedures undertaken at the same time may legitimately require two codes to fully describe
them.

In the event that more than one code is needed to describe a procedure, a new code request
should be made to CCSD so that an additional single code may be issued.

Chemotherapy and Radiotherapy Benefit Tables

Chemotherapy and Radiotherapy benefit tables are now on the Bupa Schedule of Procedures. We
will be issuing the new CCSD codes for these procedures in due course, but for now please use
the existing Bupa codes included in the table.

Dr Johann Carinus
Healthcare Commissioning
Bupa Health and Wellbeing UK




Edition 4
June 2010
Edition 4
June 2010

				
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