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December 2011
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The National Tariff: How Chemotherapy May Be Funded
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The chemotherapy HRG
The structure of the new chemotherapy HRG was devised by an expert working group (EWG) of multidisciplinary clinicians and finance representatives.3 Under Payment by Results, chemotherapy will be funded separately to other treatments the patient may be receiving. The different chemotherapy regimens are grouped into bands and allocated OPCS and HRG codes. There are two sets of codes, based on the NHS procurement costs (procurement codes) and the resources needed for delivery (delivery codes). For example, FEC (fluorouracil+epirubicin+cyclo-phosphamide) is a Band 2 regimen, which has procurement OPCS code X702 and procurement HRG code SB027, whereas FEC 100 is in Band 3, and has procurement codes X703 (OPCS) and SB03Z (HRG). The full cost of procurement is assigned to day 1 of any cycle of treatment.
The delivery tariff does not apply to inpatients, since the cost of delivering inpatient chemotherapy is considered to be already included in the bed tariff. It comes into effect wherever outpatient treatment is given. Delivery codes are designated as shown in Table 1.
Where a regimen has multiple attendances per cycle, the first attendance is coded according to resource use as described in the bands, but any subsequent attendance is coded as ‘Deliver subsequent elements of a chemotherapy cycle’, i.e. X731. (OPCS) and SB15Z (HRG). This structure has been designed to strike a balance between reflecting the complexity of chemotherapy delivery and the ability of NHS coding systems to record the data. Some trusts may choose to only record day 1 visits of any particular chemotherapy cycle.
Table 1: Delivery codes for chemotherapy
Examples of the use of procurement and delivery codes for different regimens are shown in Table 2 (please see next page).
Central to the proper functioning of the chemotherapy HRG is the manual Chemotherapy Regimens & and Guidance for Clinical Coders, produced by NHS Connecting for Health (CfH).4 It lists common chemotherapies and their associated codes for procurement and delivery. It remains unclear how often and by what method the list will be updated with new regimens.
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Discussion.