Contracted hospital care service must involve all of the following:
- an agreement, between a purchaser and provider to pay for healthcare service
- a purchaser, which can be a public or licensed private hospital, or a health authority (department or Hospital and Health Service) or other external purchaser
- a provider (a contracted hospital), which can be a public or licensed private hospital
- the purchaser paying the contracted hospital for the contracted service; thus, services provided to a patient in a separate facility during their episode of care, where the patient is directly responsible for payment of this additional service, are not considered contracted services for reporting purposes
- a healthcare service, reported by the provider where the patient is admitted and/or the purchaser where the patient is admitted at the purchasing hospital
Pathology or other investigations performed at another location on specimens gathered at the purchasing hospital would not be considered contracted services for reporting purposes.
Allocation of diagnosis and procedure codes should not be affected by the contract status of an episode. The Australian Coding Standards should be applied when coding all episodes of care.
Procedures performed by a private health provider (non-hospital) (i.e. not a licensed hospital) are coded. Private health providers include those organisations that would not have a Queensland Health facility number, but deliver services such as physiotherapy, radiology and pathology.
For admitted patients placed on contract leave (for part of the treatment to be provided under contract by another hospital), the episode of care (and any derived Diagnosis Related Group (DRG) should reflect the total treatment provided (all patient days and procedures). The contracted procedure(s) should be flagged, the purchaser/provider identifier recorded, and the contract leave recorded.