From 1 January 2017 public hospitals and health services must not report any new waiting episodes to the Elective Surgery Information System (ESIS) with Principal Prescribed Procedure code 509 - Plastics/Aesthetic (Cosmetic) Procedures (PPP 509). PPP 509 will be abolished to ensure that all elective surgery is publicly reported and surgical resources in public hospitals and health services are provided to patients with a medical indication. This will be formalised through removal of the PPP 509 code by 5 April 2017 following clinical assessment of all patients currently waiting for this procedure type.
This circular applies to all Victorian public hospitals and health services, with patients (public and privately funded) wait listed either in ESIS or other waiting list systems for PPP 509 procedures and aesthetic procedures. The Elective surgery access policy July 2015, including requirements related to aesthetic procedures, remains applicable to all Victorian public hospitals and health services performing elective surgery regardless of whether they report to ESIS.
From 2006 Victoria has provided policy guidance to public hospitals and health services on access to surgery for aesthetic procedures which should not be performed in Victorian public hospitals and health services unless there is a clear clinical need to improve a patient’s physical health. This guidance was incorporated into the Elective Surgery Access Policy in 2009 and updated in a circular released 23 July 2012. The 2012 circular included an expanded list of aesthetic procedures which cannot be performed in a public hospital without a medical indication and an updated list of medical indications for existing procedures. This policy guidance was reiterated with the release of the Elective surgery access policy July 2015. Refer Table 1.
In July 2003 PPP 500 codes were introduced which included PPP code 509 Plastics/Aesthetic (Cosmetic) Procedures (PPP 509). This was introduced to support public hospitals and health services who were seeking to manage all procedures being undertaken in theatre as they were using the same resources to assist them to better manage patient care. At the time this supported a wait list modelling software system that public hospitals and health services had in place that was not continued.
In April 2011 the department issued advice through the Health Data Standards and Systems (HDSS) Bulletin introducing a new PPP code to allow the reporting of medically indicated reconstructive breast procedures in ESIS data that would be publicly reported on the elective surgery wait list. From July 2016 three new reportable breast procedure codes were introduced to replace the code introduced in 2011.
The department has not issued other advice regarding reporting of procedures done in accordance with Appendix 1 of the Elective surgery access policy July 2015 .
Public hospitals and health services must ensure any patients currently awaiting PPP 509 procedures are clinically reviewed prior to 31 March 2017.
Public hospitals and health services must apologise and undertake open disclosure during the clinical review and advise all patients that they should have been coded differently.
Public hospitals and health services should only reassign or remove patients following clinical assessment of the patient. These changes should be submitted to the Department of Health and Human Services in accordance with ESIS reporting guidelines by no later than 5 April 2017. The department will work with relevant public hospitals and health services to support technical submission of the revised data. Refer Table 2.
In reviewing all patients currently waiting with PPP 509, public hospitals and health services must either:
- assign an appropriate reportable PPP code for clinically indicated aesthetic procedures (refer to Elective surgery access policy July 2015), NB no change to registration dates
- report removal details as appropriate.
Clinicians should undertake a clinical assessment of all patients awaiting PPP 509 for appropriateness and suitability for surgery. Then the patients should be assessed against the elective surgery access policy relevant at the time the patient was listed (Refer Table 1).
Patients who meet the requirements for surgery in a Victorian public hospital are to be reassigned to a reportable ESIS PPP code. (Refer Table 3). Patients’ original administrative registration date must be retained when the patient is changed to a reportable procedure code.
Patients should be treated in turn with regard to their clinical urgency category and the waiting times of existing waiting list patients under that surgical specialty or PPP code. In scheduling surgery dates public hospitals and health services are to consider the length of time patients have been waiting (under PPP 509) and prioritise those who have been waiting the longest.
Patients who do not meet the requirements for surgery in a Victorian public hospital are to be removed from the Elective Surgery Information System. Public hospitals and health services are to consider the medical and psychosocial needs of these patients and arrange access to appropriate non-surgical services and assistance. Data must also be submitted to the department for these patients prior to 5 April 2017.
Public hospitals and health services requiring assistance can contact the Department of Health and Human Services via the Elective Surgery Access Line on 1300 781 821.
Appendix 1 Guidelines for aesthetic surgery on the public hospital waiting list - April 2006
Appendix 2 Elective surgery access policy July 2009
Appendix 3 Circular: Section 5 - Referring patients for elective surgery
Appendix 4 HDSS Bulletin Issue 163 - not currently available online - to be published online in early January
Appendix 5 HDSS Bulletin Issue 205 - 11 August 2016
Appendix 6 Elective surgery access policy 2015