Coding
On this page you will find information about coding for breast procedures
- The national prices are set by the pricing team at NHS England and the current 2-year 2023/25 tariff is effectively a roll-over of the 2022/23 prices and therefore not up for review. NHS England, therefore, will not be doing a costing exercise this year.
- The DIEP tariff has had an uplift, with the tariff being about £11k for a unilateral and £16k for a bilateral.
- The Breast Case mix Clinical Expert Working Groups (EWG) were asked by NHSE pricing team to review a draft of the proposed prices for 2022/23 that initially came out of their cost to pricing model.
- The published 2022/23 prices were significantly different to the initial draft prices – for breast reconstruction there was a significant amendment to the price relativities between all the HRGs as a result of the EWG feedback.
- If the tariff does not cover the cost, NHSE can look at changing this for 24/25.
- The tariff is not necessarily what each Trust is getting paid as this will vary depending on case complexity and the allocated market forces uplift.
- NHS England are taking into consideration the issue with tariffs and it causing barriers for patient care and not allowing for the expansion of services.
- All units doing free flap breast reconstruction are please requested to discuss with your finance teams and let us know if you were a) aware of the tariff uplift and b) does it cover the costs please respond to Lucy Davies
The latest Office of Population Censuses and Surveys (OPCS) as the Classification of Surgical Operations was released in April 2023. There are many new Breast Surgery Procedure Codes in OPCS 4.10, which reflect the modern Oncoplastic and Reconstructive procedures now in use. Your Trust's coding team would have been updated and please use these nomenclatures in the operation notes. This will mean more accurate data capture at a national level and there may even be uplift in the tariffs as a few of these codes are in higher Healthcare Resource Groups.
The new codes are:
- B305: Insertion of breast prosthesis into pre-pectoral space
- B306: Renewal of breast prosthesis in pre-pectoral space
- B307: Removal of breast prosthesis from pre-pectoral space
- B396: Reconstruction of breast using free superficial inferior epigastric artery flap
- B397: Reconstruction of breast using bipedicled free deep inferior epigastric perforator flap
- B421: Reconstruction of breast using free myocutaneous gracilis flap
- B422: Reconstruction of breast using free profunda artery perforator flap
- B428: Other specified reconstruction of breast using flap of thigh
- B429: Unspecified reconstruction of breast using flap of thigh
- B431: Reconstruction of breast using free lumbar artery perforator flap
- B438:Other specified other reconstruction of breast
- B439: Unspecified other reconstruction of breast
- B441: Reconstruction of breast using pedicled intercostal artery perforator flap
- B442: Reconstruction of breast using pedicled thoracodorsal artery perforator flap
- B443: Reconstruction of breast using pedicled thoracic artery perforator flap
- B448: Other specified reconstruction of breast using flap of chest wall
- B449: Unspecified reconstruction of breast using flap of chest wall
- B451: Replacement of sub-pectoral space prosthesis with pre-pectoral space prosthesis
- B452: Replacement of pre-pectoral space prosthesis with sub-pectoral space prosthesis
- B458: Other specified other prosthesis for breast
- B459: Unspecified other prosthesis for breast
- Y453: Approach to organ under seed marker guided control
On the 1st April 2020 the latest version of the breast procedure codes (OPCS 4.9) came into effect. Karina Cox and Jennifer Hu, of the ABS Clinical Practice & Standards Committee, have written a useful summary of the key changes for breast surgeons in the UK.
