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NHS Ref – Code to Grouper and PbR Tariff on your iPhone


The NHS Reference or NHSRef app gave me such joy but it is so niche that I almost missed it.

The The NHS Reference iPhone app has been put together by the NHS Information Centre and is the perfect reference source for NHS professionals from clinicians, clinical coders, informatics analysts and finance staff. NHSRef functions as a user friendly version of the mammoth Code to Grouper spreadsheet that is used to derive payment HRGs from OPCS procedure codes and ICD diagnostic codes but it also appears to include the whole of the PbR Tariff Information spreadsheet.

So to review the NHSRef app, it includes:

Clinical Coding details: ICD-10, OPCS-4.6, A&E

Payment by Results (2011/12): HRG4, Exclusions, Top-Ups, A&E bands

Data Dictionary – Specialty, APC, OPA, A&E

Organisational Data: NHS Providers including MFF, top-eligibility and addresses.

I’ve found NHSRef to be an invaluable resource, using it to quickly access tariff information for HRGs and outpatient appointments by specialty.

If you want to track through clinical coding of patients from diagnostic and/or procedure codes it is much easier to use this app than open up the clunky code to grouper spreadsheet. I’m not in anyway a coding expert but here’s a beginners guide to costing “simple” patient spells.

Beginners Guide to Costing Patient Spells using NHSRef iPhone App

Here’s a simple example to demonstrate how you can use the NHSRef app to help you cost up a patient spell.

You need to start with the patients case notes so you can determine the diagnosis and procedures (if any).

I’ve searched for the relevant coding and entered the ICD-10 and OPCS codes above. I’ve also shown the procedure hierarchy which is clearly shown in the NHSRef OPCS tables. The hierarchy is important for grouping to spell HRGs. Both the ICD-10 and OPCS codes will group to a HRG but you need to determine the dominant one. The code to grouper user manual includes the following useful flow chart:

So in this case the total excision of a kidney has a hierarchy of 10 which is greater than 3 and so will drive the choice of HRG. Here are the relevant screens from NHS Ref, all accessed initially from the the OPCS screen.

You can now complete the coding document to determine the income generated by the provider trust.

Reference NHS

Doctor Moxie

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NHS Accountant with geeky tendencies - serial blogger on subjects varying from Excel, Raspberry Pi, productivity, allotment gardening and running. The NHSExcel blog is reserved for Excel topics.

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