Saudi: Healthcare Updates to Saudi Billing System & Coding Standards

Last year the Council for Health Insurance ("CHI") issued version 2 of the Saudi Billing System ("SBS") and the Saudi Billing System Coding Standards ("SBSCS"), which was implemented on 1 June 2023 ("SBS V2"). SBS V2 includes additional codes to those in V1, including non-billable codes; take care not to miss these additional codes that are required to be coded.

However, while SBS V3 is not officially launched yet, CHI is conducting workshops to a preview and deeper understanding of the expected new classifications and governance frameworks. This article focuses on V2 of 2023.

SBS V2

SBS V2 (which includes SBS and SBSCS updates) updates and replaces the previously released "Standards and Guidelines of CCHI Billing System" of July 2020, and must be used in conjunction with the Australian Consortium for Classification Development (2017) Australian Coding Standards ("ACS") (both standards are to be reviewed together). Thus, this updated document should be used in conjunction with ACS 10th Edition.

The SBS is a modification to the Australian Classification of Health Interventions ("ACHI"). According to CHI, the purpose of the SBS is to standardise data for claims, and for morbidity analysis and mandated reporting. CHI states that the SBS enables the translation of diagnoses and procedures and other health problems from words into an alphanumeric/numeric code, which permits easy storage, retrieval and analysis and use of the data.

Specifically, CHI reports that the ACHI codes have been modified for Saudi Arabia to allow inclusion of additional codes (including laboratory and pathology, ambulance and transport services, service codes or billing services) and further splits on unilateral/ bilateral procedures. SBS retains the same core 7-digit code as ACHI and includes two-digit extensions where greater specificity has been added to an ACHI code, including laterality.

The term 'clinician' is used throughout the document and refers to the treating physician but may also refer to midwives, nurses and allied health professionals

Key Updates:

SBS V2 includes the following key updates:

SBS

• 765 new SBS codes;
• 1,531 revised descriptions;
• 132 deleted (inactivated) SBS codes;
• 2 new chapters (including Emergency Medical Services and Mortuary Services); and

• 4 new blocks.

SBSCS

• 62 new standards (including General standards, Dental Services Imaging Services, KSA Services, Emergency Medical Services, Ambulance and Mortuary Services chapters).

SBS Background:

The private health insurance market in Saudi Arabia is regulated by the CHI. To support the market, one of CHI's strategic aims is to provide a standardized code set for billing interventions that providers submit to health insurers. The following healthcare services rendered in an ambulatory, secondary, or tertiary environment should be coded and billed:

1. Outpatient Medical Services;
2. Admitted Care Medical Services;
3. Consultation & Rounding Services;
4. Dental Services;
5. Laboratory & Pathology Services;
6. Radiology and Imaging Services;
7. Ambulance & Transportation Services;
8. Mortuary Services;
9. Emergency Medical Services (EMS); and
10. Room & Board.

The SBSCS are based on the ACS for the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification ("ICD-10- AM") and ACHI, both 10th Edition.

The SBS includes the following classification standards:

• ICD-10-AM;
• SBS procedure codes;
• SBSCS;
• ACS;
• the Saudi Food and Drug Authority ("SFDA") -GTIN - for Medications and Herbals/Vitamins; and
• the SFDA -GMDN -for Medical Devices and Consumables.

As of 01 January 2020, Saudi Arabia has mandated the 10th Edition of ICD-10-AM/ACHI/ACS. SBS is built on the Australian systems, specifically ICD-10-AM and ACHI, but differs from the Australian system in two fundamental ways, as reported by CHI:

1. "Many new codes have been added (for example, for laboratory, evaluation and management-type interventions, emergency services, laboratory and pathology, and mortuary), more extensive unilateral and bilateral splits and the code structure has been modified from ACHI;
2. SBS is intended for both admitted and non-admitted care, unlike ACHI. Non-admitted care includes hospital outpatient visits, office-based specialist physician visits, emergency department visits, home health care and primary care".

Stay tuned for further updates on launching of V3!