News / Department reissues pre-op rules

Revised guidance has been issued by the Department of Health on the treatment of pre-operative assessments under payment by results after concerns were raised over contradictions in earlier advice. 

The Department issued a factsheet on outpatient tariffs during the summer in which it stated that ‘the general assumption is that pre-operative assessment costs are included in the inpatient tariff’. However NHS trusts, which typically charge a separate outpatient tariff for these assessments, challenged this interpretation. They claimed that this was in conflict with existing guidance on how costs should be allocated for reference costs and with data definitions provided by Connecting for Health.

In October managers’ call for clarity was answered with the issue of a revised fact sheet. This made it clear that pre-operative assessment costs would only be covered by the inpatient tariff if the assessment takes place on the day of admission. For assessments made on days prior to the day of admission, and meeting the definition of a pre-booked consultant-responsible clinic, an outpatient tariff will apply.

Trust managers welcomed the clarification, suggesting the guidance was now consistent with reference cost rules and existing practice.

They also said recognising that pre-operative assessments rightly attract an outpatient tariff would help avert time-consuming discussions with commissioners about the implications of a changed approach to the rules.