Suggested Read Code Lists for Templates, 6 new Enhanced Services, v0

							Suggested Read Code Lists for Templates:
Enhanced Services 2008-09

Enclosed are some short lists of codes that practices may wish to include in their
templates. The codes are related to payment and / or to quality / activity markers in
Enhanced Services that were launched since April 2008.



Contents:

   1. Version control table

   2. Introduction

   3. Diabetes LES

   4. COPD LES

   5. Heart Failure LES

   6. Alcohol LES

   7. Sexual Health LES

   8. Ethnicity LES

   9.   Ethnicity DES

   10. Learning Disabilities LES

   11. Care Homes LES

   12. IUCDs

   13. Minor Surgery

   14. Child Protection LES

   15. Prevalence Incentive Scheme



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(1) Version Control Table

 Version       Author       Details of Changes      Other Comments
 Number and
 Date
 V0.01         R Nicholls First Draft of Read       Sent to J Duddle for comments on format.
 18/11/2008                 code lists,
                            incorporating           Needs the following checks (I Patel):
                            selected codes from
                                                         1)  All descriptions of codes in this match the code
                            Adebayo Akande’s                 descriptions in the Read code database (or
                            Explanation of ES                EMIS LV if database not working)
                            Indicators                   2) All read codes listed in this document under an
                                                             enhanced service are included somewhere in the
                                                             latest version of the business rules or MIQUEST
                                                             query set for that service (excluding Ethnicity
                                                             DES)
                                                         3) The extra advice included next to codes /
                                                             descriptions in this document (e.g. advice on
                                                             Value prompts or required free text)
                                                             corresponds to similar advice in ““ES
                                                             Indicators READ Codes May 2008 v1.0.doc”
                                                         4) The numerator of every indicator in the ES
                                                             Scorecard for the 6 LESs in this document
                                                             (excluding Ethnicity DES) includes at least one
                                                             code which is listed in this document.
                                                             e.g.for the indicator “Blood Sugar 3y in high
                                                             risk (including BMI>=30)”, the Business rules
                                                             show that the numerator includes patients with
                                                             code “44f”, which is in this document.
                                                    5) Any comments / suggested changes to wording

                                                    Also needs brief check by RN.



 V0.02         I Patel      Full checks complete.
 18/11/2008                 1 erroneous code
                            Correction made.
                            Issues highlighted to
                            RN.


 V0.03         R Nicholls Issues raised by RN       Now ready for circulation at ES Review Event, technical
 26/11/2008                 reviewed – no further   checks complete.
                            action, Correction
                            accepted                However, this is a draft work in progress. The following
                                                    are required to move this forward:

                                                         1)   Addition of read code categories required for
                                                              templates as well as example codes and
                                                              descriptions, in a table with 3 columns.... e.g.
                                                              sexual health template Column 1(code
                                                              category): a read code for diagnosis of
                                                              chlamydia, Column 2 (Read code): Ayu4K,
                                                              Column 3 (Read code description):
                                                              [X]Chlamydial infection of genitourinary tract,
                                                              unspecified
                                                         2)   Ensure that example read codes tie in with the
                                                              ones chosen in EMIS QOF templates
                                                         3)   Review by PCT practice data quality facilitators
                                                         4)   Ideally review by some practices / GPs before
                                                              wider circulation




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 Version       Author     Details of Changes   Other Comments
 Number and
 Date
 V0.04         R Nicholls Codes for
 06/01/2009               recording First
                          Language in
                          Ethnicity DES –
                          updated and typo
                          corrected.

 V0.05         I.Patel    ‘READ Codes          READ Codes for the following combined in this document:
 21/01/2009               Summary List for     Learning Disabilities LES / Care Homes LES / IUCDs /
                                               Minor Surgery / Child Protection LES / Prevalence
                          ES Part 2            Incentive Scheme
                          v0.05.doc’
                          combined with this
                          list.
 14/01/2009    R.Nicholls Altered Blood
 &                        pressure codes to
 23/01/2009               be compatible with
                          EMIS LV system
                          set up (as per M
                          Clarke’s advice)




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(2) Introduction:
Suggested Read Code Lists for Templates for Enhanced
Services
Enclosed are some short lists of codes that practices may wish to include in their
templates. The codes are related to payment and / or to quality / activity markers in
Enhanced Services that were launched since April 2008.

Where codes / clinical terms are marked with an asterisk (*) there are alternative
codes with similar meanings that are also picked up by the Enhanced Services data
collections. There are often many different codes which count towards the same
targets in Enhanced Services. It is ultimately up to the practice to decide which codes
are most appropriate clinically to include in their data entry templates, and which ones
to add to add to each individual patient’s record. Practices have previously been
provided with a full list of codes included in Enhanced Services Monitoring (see
section 2 of
“ES Indicators READ Codes May 2008 v1.0.doc”; Note that a new code has been
included in the monitoring since that document was written - 9Oy0 – “Invitation to
Diabetes Screening”)

While every effort has been made to check these lists of Read codes, they cannot be
guaranteed to be accurate or complete.

This document is a draft work in progress, with some improvements planned for the
future. In addition, we would welcome any comments or suggestions for further
improvements to this document, or to any aspect of Enhanced Services Monitoring /
other documentation re Enhanced Services, please contact
EnhancedServices.Camden@nhs.net .




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(3) LES For Identification of Diabetes:
C10E          Type 1 diabetes mellitus*
C10F          Type 2 diabetes mellitus*
C11y2         Impaired Glucose Tolerance*
C11y3         Impaired Fasting Glycaemia*

22K           Body Mass Index*
2469          O/E – systolic blood pressure reading
246A          O/E – diastolic blood pressure reading
44f, 44g      Blood Glucose*
9Oy0          Invitation to Diabetes Screening

(4) COPD LES:
H3            COPD*
68M           Spirometry Screening*
8I3b          Spirometry Declined
9OOZ          Stop Smoking Monitoring NOS (to be used for in-house COPD Smoking
              Assessments)
173H          MRC Breathless Scale: grade 1
173I          MRC Breathless Scale: grade 2
173J          MRC Breathless Scale: grade 3
173K          MRC Breathless Scale: grade 4
173L          MRC Breathless Scale: grade 5
339S          FEV1 as a percentage of predicted PLUS VALUE (0 to 100)
8A44          Pulse Oximetry Monitoring PLUS VALUE (0 to 100)*
65720         Pneumococcal Vaccination Given*
8I3Q          Pneumococcal Vaccination Declined*
8I2E          Pneumococcal Vaccination Contraindicated*



(5) Heart Failure LES:
G58           Heart Failure*
2469          O/E – systolic blood pressure reading
246A          O/E – diastolic blood pressure reading
44J3, 44JF    Creatinine codes*
65720         Pneumococcal Vaccination Given*
8I3Q          Pneumococcal Vaccination Declined*
8I2E          Pneumococcal Vaccination Contraindicated*
8I26          Beta blocker contraindicated*
8I36          Beta blocker therapy refused
8I62          Beta blocker not indicated
8I73          Beta blocker not tolerated

68B6          Heart Failure screen (To be used in patients at High Risk of Heart Failure who have
              been asked regarding symptoms of Heart Failure)
1J60          Suspected Heart Failure (To be used in patients at High Risk of Heart Failure with
              Symptoms Suggestive of Possible Heart Failure)
44AP          Serum pro-BNP level
44AN          Plasma pro-BNP level
33BD          Echocardiogram requested*
56F1          Echocardiogram declined
58530         Echocardiogram normal*
585g          Echocardiogram shows left ventricular diastolic dysfunction
585f          Echocardiogram shows left ventricular systolic dysfunction
58531         Echocardiogram abnormal*

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5C20             Echocardiogram equivocal

(6) Alcohol LES:

9k17             Audit C completed
136              Alcohol Consumption
8CAM             Patient advised about alcohol (code for Brief Interventions)
9k11             Alcohol Consumption Counselling (code for Extended Brief Interventions) – Free
                 text needs to be added to this code (see table below)
8BA8             Alcohol Detoxification (add “By Practice” in free text to this code when the
                 Detoxification is carried out by the practice in accordance with Level 3 of the
                 Alcohol LES)



Free Text to add to code 9k11 for Extended Brief Interventions:
Where and by Whom Extended Brief Intervention       Precise Free Text to enter with code 9k11
Carried out:
Referral and accepted to outside alcohol service    By Outside Agency
Delivery by in-house advisor from sensible drinking In House By Sensible Drinking Advisor
service
Delivery by competent practice staff member         By Practice




(7) Sexual Health LES:
9kF0             Sexual Health Enhanced Service Completed (add to ALL patients given care under
                 the terms of the Sexual Health LES)*

4JQA.            Gonorrhoea test positive*
A98              Gonococcal infections*
Ayu4K            [X]Chlamydial infection of genitourinary tract, unspecified*
AD10             Urogenital Trichomonas*
A910             Primary genital syphilis*
A97z             Syphilis NOS*
A541             Genital Herpes Simplex*
A7881            Asymptomatic HIV infection
A788             Acquired Immunodeficiency Syndrome (AIDS)*
A788y            HIV with other clinical findings*
A703             Viral (serum) Hepatitis B*
ZV02B            [V]Hepatitis B carrier*
A70z0            Hepatitis C*
ZV02C            [V]Hepatitis C carrier*

679S             Health education - safe sex*
65X              Contact tracing*
9Op0             HIV screening offered
8I3p             HIV screening declined




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(8) Ethnicity LES:
9i%              (All codes beginning with 9i but not 9i itself) – 2001 census ethnic categories



(9) Ethnicity DES (Language Codes):
(The Ethnicity DES, launched in September 2008 by the Department of Health, includes a
target related to coding of main spoken language)
13l%                (one-three-small-el) (Any code beginning with “13l”) –
                   Main Spoken Language codes
13u%                (Any code beginning with “13u”, but not 13u itself!) –
                   More Main Spoken Language codes
13w%                 (Any code beginning with “13w”, but not 13w itself!) –
                   Yet More Main Spoken Language codes
13ZM                Using British Sign Language
13ZP                Using Makaton Sign Language

Very rarely there will be no read code specifically for the patient’s main spoken language; in
such a case the practice should enter the code 13l (one-three-small-el), “main spoken
language” and add the patient’s language to this code in free text.


(10) Learning Disabilities LES:
918e             On learning disability register

Body Mass Index:
22K        Body Mass Index

Smoking Status:
1371       Never smoked tobacco
137R       Current smoker
137S       Ex-Smoker

Lifestyle Advice:
8CAL         Smoking cessation advice
8CA4         Patient advised re diet
8CA5         Patient advised re exercise

Medication Review:
8B3V        Medication review done
8I3V        Medication review declined

Individual Health Action Plan:
9HB0         Learning disabilities health action plan declined
9HB1         Learning disabilities health action plan offered
9HB2         Learning disabilities health action plan reviewed
9HB4         Learning disabilities health action plan completed




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(11) Care Homes
Codes For Denoting that Patients are In Care Homes:
13FX       Lives in care home
8CW        Provision of GP intermediate care

Blood Pressure:
2469       O/E – systolic blood pressure reading
246A       O/E – diastolic blood pressure reading

Medication Review:
8B3V        Medication review done
8I3V        Medication review declined

Weight:
22A             O/E – weight

Influenza vaccination:
65E          Influenza vaccination
9OX5         Influenza vaccination declined

Pneumococcal vaccination:
65720     Pneumococcal vaccination given
8I3Q      Pneumococcal vaccination declined

Allergies:
1151            No known allergies
U60%            Various codes for Adverse reactions to medications
SN58%           Various codes for food allergies
SN59%           Various codes for venom / bite / sting allergies




(12) IUCDs
Contraception Advice:
611         General contraceptive advice
614F        Emergency contraception advice

(To record that patients have been offered advice on the range of contraceptive options
available to them prior to fitting.)

Chlamydia Screening:
4JK9       Endocervical chlamydia swab
9Oq0       Chlamydia test offered
8I3T       Chlamydia screening declined

Successful Fitting of IUCD / IUS:
6151        IUD fitted
6153        IUD re-fitted
61A2        IUD fitted for ‘morning after’ emergency contraception

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7E094           Introduction of Mirena coil

Unsuccessful IUCD Fitting Attempt:
615J       Unsuccessful intrauterine contraceptive device insertion

Completion of IUCD Fitting Enhanced Service:
9kA0       IUCD fitting - enhanced service completed

(Code 9kA0 should be entered after a successful IUCD fitting carried out by the practice in
accordance with the terms of the Enhanced Service).

Initial Review of IUCD After Fitting:
615L          IUD 6 week check

Annual Review of IUCD
615K       IUCD annual review

Complications of IUCDs
K4z        Female pelvic inflammatory disease NOS
615E       IUCD threads lost
SP032      Mechanical Complication of IUCD (includes perforation)



(13) Minor Surgery
Codes for Injections (muscles, tendons and joints):
(This does not include intramuscular injections or local anaesthetic given prior to performing a
minor surgery procedure.)

Minor surgery done – injection           9877
Injection into joint                     7K6Z3

Free text must be added to the above codes with clinical detail for monitoring purposes (not
patient identifiable).

Codes for Invasive Procedures:
(N.B. Cryotherapy, curettage and cauterisation continue to be provided as an
additional service and are not payable as part of the Minor Surgery Enhanced
Service.)

Minor surgery done – aspiration          9878
Minor surgery done – incision            9879
Minor surgery done – excision            987A
Minor surgery done – other               987B

Free text must be added to the above codes with clinical detail for monitoring purposes
(not patient identifiable). Please supply sufficient detail in free text to enable clinical
assessors to verify the claim, making clear that the procedure was invasive, this might include
details of size of lesion; use of local anaesthetic and suturing can be coded (see
supplementary codes below).

Consent:
Consent given for minor surgery procedure                 8923

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Supplementary codes:
Primary suture of skin                    7G210
Local anaesthetic                         7M34

Histology:
Tissue sent for histology                 4K11
Histology normal                          4K13
Histology abnormal                        4K14
Histology nos                             4K1Z
Histology nonsp. finding                  R15

(14) Child Protection LES
Name of Primary Carer
(To be recorded for all newly registered children):

9180             Carer’s Details                   OR
918H             Primary Carer

(Whichever code you use, please add the name of the child’s main carer in free text)

(Note: 9180 is the best code to use; 918H can still be used and is included in the LES
monitoring; the problem with 918H is that some nationally-written flu searches assume that
children with 918H in their record are themselves carers and that they therefore should have
flu vaccination!)

Name of School
(To be recorded for all newly registered children, especially if aged 5+ years):

13Z4             Schooling

(please add the name of the school in free text)


Child Protection Register:

13Id             On Child Protection Register
13IO             Child removed from protection register



Social Worker:
(To be recorded for all children on the Child Protection register):

13G4             Social worker involved

(Please add the name and phone number of the social worker / relevant area office in free
text)




Health Visitor:
(To be recorded for all children aged <5 years on the Child Protection register):

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13G2             Health Visitor Visits

(Please add the name of the child’s health visitor in free text)




(15) Prevalence Incentive Scheme

CVD risk:
662k                     JBS CVD risk <10% over next 10 years
662l                     JBS CVD risk ≥10 to ≤20% over next 10 years
662m                     JBS CVD risk >20 to ≤30% over next 10 years
662n                     JBS CVD risk >30% over next 10 years
EMISNQFR5                10 year CVD Risk (EMIS systems only)
EMISNQFR8                Estimated 10 year CVD Risk (EMIS systems only)


CHD Risk:
3888                     10 year CHD Framingham Risk
388R                     10 year adjusted CHD Framingham Risk
EMISFR3                  10 year CHD Framingham Risk (EMIS systems only)
EMISFR4                  Estimated 10 year CHD Framingham Risk
                         (EMIS systems only)


Heart Failure:
G58          Heart Failure
68B6         Heart Failure screen
1J60         HF suspected
1I10         HF excluded


Diabetes:
C10E             Type 1 Diabetes
C10F             Type 2 Diabetes
Patients who were pregnant at the time of the diagnostic blood tests should have gestational
diabetes entered into their record (L1809).




Other Relevant Read Codes:
C11y2       Impaired Glucose Tolerance
C11y3       Impaired Fasting Glycaemia


Hypertension
G2         Hypertensive Disease



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