Coding

• 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 (lucydavies@absgbi.org.uk)

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.  To view the summary please click here