Fertility tariff defeated by coding row

The Department of Health has abandoned an attempt to develop a specialist tariff for fertility services after being refused the necessary clinical codes.

In a move that highlights ongoing problems with NHS data and its uses, the Assisted Reproduction and Embryology Policy team at the DH has abandoned attempts to develop an NHS National Tariff for Regulated Fertility Services after being refused the required codes on the grounds of cost and sensitivity.

The expert group was set up in 2008 to try to overcome barriers to implementing NICE guidance on fertility treatment, one of which was a national tariff to support payment for services.

National tariffs are based on codes authorised by OPCS-4; which was previously produced by the Office of Population Censuses and Surveys, but which is now maintained by NHS Connecting for Health.

The codes are reviewed annually. The policy group requested codes from the Editorial Board, but these were refused.

In an email, Peter Taylor, project manager of the assisted reproduction team at the DH, wrote: “As one of the steps towards developing an NHS National Tariff for Regulated Fertility Services, we required the authorisation of OPCS Codes for publication within this year’s HRG 4 Listings.

"This is to allow us to collect data from providers of NHS funded regulated fertility services, which is vital to the successful development of NHS national tariff.

“Unfortunately, the OPCS Editorial Board refused these codes on various grounds relating to the burden of data collection and the sensitivity of the data required, and although we worked to allay the concerns of the Board, a subsequent appeal failed.”

The project is now in abeyance, although Taylor added that a fresh attempt to gain the codes might be made in spring 2012.

Sue Eve-Jones, director of the Professional Association of Clinical Coders, said the decision was “utterly bizarre”.

Data used in coding is anonymised, so the sensitivity argument should not apply, she said. “It’s just cobblers. It would be like saying you could not collect data because someone has syphilis or HIV.”

The debacle also highlighted the increasing confusion about the role of the OPCS-4 and coding classifications.

“As coders we are no longer clear about whether we are collecting data to support the payment system or to collect data around the patient. Despite the fact that we are told it is the latter, it seems we are operating more and more in a US-style payment system.”

A Department of Health spokesperson said: “The issue here is about the appropriate use of the classification and in this instance the OPCS-4 classification would not satisfy the particular data collection requirements.

“Coding is used when classifying for broad analysis. There are other more appropriate tools and methodologies where fine detail is required such as SNOMED and the Dictionary of Medicines and Devices.”