NHS Digital released HRG4+ Consultation Grouper for 2022/23

On December 17, 2021, NHS Digital released HRG4+ Consultation Grouper for 2022/23. This release is used to support the NHS England and Improvement consultation process for the 2022/23 National Tariff Payment System. This Consultation Grouper will be superseded by the 2022/23 Local Payment Grouper in March 2022, for use from April 01, 2022.

In general, there are significant changes in base HRG design. A total of 120 new HRGs were created, and multiple HRGs were removed, so the total number increased by 62 from 2,838 to 2,900. Many HRG chapter/subchapter labels and individual HRG names have been amended to ensure they accurately reflect the content. The grouping logic was updated to accommodate National coding recommendations and new guidelines from NICE. This includes the remapping of existing codes and the creation of new combination codes, where appropriate.

Some examples of new HRGs are provided below.

Four new HRGs were created to specifically identify additional expected resource usage of patients that have implantation of ICD or ICD-CRT alongside major surgery, e.g., CABG or valve repair, or complex patients that require device extraction before renewal. See examples below:

• EY14B Implantation of Cardioverter Defibrillator with Cardiac Resynchronisation Therapy, with Extraction or Major Open Procedure, with CC Score 0-8;
• EY15B Implantation of Cardioverter Defibrillator, with Extraction or Major Open Procedure, with CC Score 0-8.

Aortic repair procedure HRGs were reviewed and redesigned across both cardiac and vascular subchapters leading to the removal of several HRGs, the creation of 32 new HRGs new ones, and multiple logic changes. See examples of new HRGs below:

• ED16Z Hybrid Repair of Descending Thoracic Aorta or Aortic Arch;
• YQ09A Standard Open Repair of Abdominal Aortic Aneurysm with CC Score 7+;
• YQ09B Standard Open Repair of Abdominal Aortic Aneurysm with CC Score 4-6;
• YQ09C Standard Open Repair of Abdominal Aortic Aneurysm with CC Score 0-3;
• YR66A Complex Endovascular Repair of Abdominal Aortic Aneurysm, with CC Score 6+;
• YR66B Complex Endovascular Repair of Abdominal Aortic Aneurysm, with CC Score 0-5;

Nineteen new HRGs concerning gastrointestinal procedures were added. Fourteen of them were created for endoscopic procedures to differentiate expected resource use between pre-school and school-aged children, and a redesign combined upper and lower gastrointestinal tract endoscopy HRGs to differentiate expected resource use between colonoscope and sigmoidoscope. Some examples are provided below:

• FE23C Endoscopic or Intermediate, Upper Gastrointestinal Tract Procedures, between 5 and 18 years;
• FE23D Endoscopic or Intermediate, Upper Gastrointestinal Tract Procedures, 4 years and under;
• FE41Z Diagnostic, Upper Gastrointestinal Tract Endoscopic Procedure with Colonoscopy, with Biopsy, 19 years and over;
• FE43Z Therapeutic, Upper Gastrointestinal Tract Endoscopic Procedure with Sigmoidoscopy, 19 years and over;

Three new HRGs were added under the newly created subchapter YC “Head and neck imaging interventions.” New combination codes classifying imaging interventions are mapped to this subchapter, and existing codes from subchapters CA “Ear, nose, mouth, throat, head and neck procedures” and KA “Endocrine system procedures and disorders” were remapped to this subchapter:

• YC01Z Percutaneous Core Needle Biopsy of Lesion of, Head or Neck;
• YC02Z Percutaneous Fine Needle Aspiration Biopsy of Lesion of, Head or Neck;
• YC10Z Percutaneous Therapeutic, Head or Neck Procedures.

Twenty new HRGs concerning obstetrics and gynecology were introduced. Some of them aimed to identify activity undertaken at gynecological “one-stop” clinics and to differentiate these based on expected resource use associated with undertaking multiple exams or minor procedures concurrently. See some examples below:

• MA41Z Transvaginal Ultrasound with Biopsy and Implantation of Intrauterine Device;
• MA43Z Transvaginal Ultrasound with Salpingography;
• MA47Z Diagnostic Hysteroscopy with Transvaginal Ultrasound and Implantation of Intrauterine Device.

Eight new HRGs were created concerning orthopedics, including the following:

• AB27Z Injection of Therapeutic Substance into Joint Under Image Control for Pain Management;
• YH30A Percutaneous Aspiration of Joint, 19 years and over;
• YH32A Percutaneous Biopsy of, Lesion of Muscle or Connective Tissue, 19 years and over.

Two new HRGs were added concerning procedures on the prostate: YL30Z “Percutaneous Ablation of Lesion of Prostate” and YR59Z “Prostate Artery Embolisation.”

See the full details here.

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