Q&A

I agree it is really confusing. Open the GMS template for Stroke/TIA and click on the second tab. If you click on the QOF symbol on the template next to the CT/MRI link it will open up the QOF cluster and sitting in there is the referral code to the Stroke services

 

Version 2

8HTQ.     Referral to stroke clinic

8HBJ.     Stroke / transient ischaemic attack referral

8HQ4.     Refer for CAT scanning

8HQ3.     Refer for NMR scanning

CTV3

XaJkS      Stroke / transient ischaemic attack referral

XaJYc      Referral to stroke clinic

XaXOh    Referral to transient ischaemic attack clinic

Patient in the past would have been coded with an entry of Intermittent Claudication and this group of patients should automatically be picked up and form part of your register. You may also wish to audit patients with Diabetes who have problems with circulation.

CTV3 – SystmOne

G73z. Peripheral vascular disease NOS
Gyu74 [X]Other specified peripheral vascular diseases
Xa0lV Peripheral vascular disease
XaZJa Ischaemic lower limb pain at rest
XE0VP Other peripheral vascular disease
XE0VR Intermittent claudication

Version 2 – Isoft, Vision, EMIS and Microtest.

G73.. Other peripheral vascular disease
G734. Peripheral arterial disease
G73y. Other specified peripheral vascular disease
G73z. Peripheral vascular disease NOS
G73z0 Intermittent claudication
G73zz Peripheral vascular disease NOS
Gyu74 [X]Other specified peripheral vascular diseases

 

 

There is a low exception Read Code for refusal of BP

Version 2 Read Codes

8I3Y.                    Blood pressure procedure refused

CTV 3 Read Codes

XaJkR                   Blood pressure procedure refused

It is now possible to record a patient whose illness is in remission by entering one of the ‘in remission’ Read Codes. The patient will remain on the register but will be excluded from MH10-MH16 inclusive.

What constitutes ‘remission’ from serious mental illness can be found on page 21 of the Quality and Outcome Framework guidance book

The following codes are available:

Mental Health, new codes CTV 3 Version 2
Schizophrenia in remission E1005 E1005
Hebephrenic schizophrenia in remission E1015 E1015
Hebephrenic schizophrenia in remission E1015 E1015
Paranoid schizophrenia in remission E1035 E1035
Latent schizophrenia in remission E1055 E1055
Schizo-affective schizophrenia in remission E1075 E1075
Single manic episode in full remission E1106 E1106
Recurrent manic episodes, in full remission E1116 E1116
Bipolar affective disorder, currently manic, in full remission E1146 E1146

 

Bipolar affective disorder, currently depressed, in full remission E1156 E1156
[X]Bipolar affective disorder, currently in remission Eu317 Eu317
Mixed bipolar affective disorder, in full remission E1166 E1166
Unspecified bipolar affective disorder, in full remission E1176 E1176
[X]Single major depressive episode, severe, with psychosis, psychosis in remission XaX53 Eu329
[X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission     XaX54 Eu32A
[X]Nonorganic psychosis in remission XaX52 Eu26.
[X]Paranoid state in remission XaX51 Eu223

 

 

 

 

 

 

If the therapeutic range is acceptable for the patient you should code the patient with the following code:

44W80  Lithium level therapeutic

This Read Code for both Version 2 and CTV 3 Read Codes

 

There are exception codes that can be added to the patient’s record but this will remove them from the indicator. The indicator is about prevention of secondary fragility fractures. Unfortunately the two patients on the register both refusing the bone sparing agents, would be removed and the indicator will again be zero for achievement. The patient needs to have had a prescription printed in the last six months of the QOF year (1st October onwards). If the patient has had a script since the 1st October 2018 then you would have achieved the indicator.

There was a criteria change for the fragility fracture for the 75yrs and over  in 2014/15. The fragility fracture has to have occurred on or after 1st April 2014. See criteria below:

 

The register is split in to two, the 50-74 year olds and the 75 and over.

 

For the 50-74 years the patient would require

  • A diagnosis at any point in their history of osteoporosis
  • A DEXA scan at any point in their history confirming diagnosis
  • A fragility fracture after the 1st April 2012.

 

For the 75yrs and over they only require

  • A diagnosis at any point in their history of osteoporosis
  • A fragility fracture after the 1st April 2014.

 

Most elderly people with a fracture in this age group are considered to be a fragility fractures so for the upper age I would do a fracture search and look at those the Hospital have started on the meds such as the calcium and vitamin supplements and discuss with the GP.

 

Your first step should be:

 

  • Look at all the fractures that have happened after the 1st April 2012. If you have admin staff coding they may not have coded them correctly. The codes required are:

CTV3                                      Version 2

XaNSP                                   N331N

XaIIp                                      N331M

 

Look at those who have been started on a supplement by the hospital after a fracture.

Once you have ensured the code is correct for the patients fracture  you may need to look back in their history and check a QOF code has been used for the DEXA, as it is at any time in the patients history (If we turn the clock back ten years we used generic codes for diagnostic tests so you may find a DEXA recorded incorrectly)

A number of practices have also found the osteoporosis was not coded just the scan.

Looking at QOF the majority practices have managed to identify patients, the average range is between 1 – 14 patients. I spoke to a practice with 11000 patients yesterday and they have 2 patients. The hardest is ensuring the coding is correct for fractures. This is where the admin staff needs clinical input as not all fragility fractures are clear on the discharge letters.

 

A fragility fracture is when a fracture is sustained as a result of low trauma or lesser force such as a fall from a standing height. It includes vertebral fractures but usually not fractures of the skull or bones of the hand or feet. For example:

Slipping and breaking a hip is worth investigating depending on the surface / weight of person etc. A break from a very minor event such as turning an ankle, coughing and cracking a rib would almost certainly be included

 

The register is split in to two, the 50-74 year olds and the 75 and over.

For the 50-74 years the patient would require

  • A diagnosis at any point in their history of osteoporosis
  • A DEXA scan at any point in their history confirming diagnosis
  • A fragility fracture after the 1st April 2012.

 

For the 75yrs and over they only require a fragility fracture after the 1st April 2012. Most elderly people with a fracture in this age group are considered to be a fragility fractures so for the upper age I would do a fracture search and look at those the Hospital have started on the meds such as the calcium and vitamin supplements and discuss with the GP.

Your first step should be:

  • Look at all the fractures that have happened after the 1st April 2012. If you have admin staff coding they may not have coded them correctly. The codes required are:

CTV3                                      Version 2

XaNSP                                   N331N

XaIIp                                      N331M

 

 

  • Look at those who have been started on a supplement by the hospital after a fracture.
  • Once you have ensured the code is correct for the patients fracture  you may need to look back in their history and check a QOF code has been used for the DEXA, as it is at any time in the patients history (If we turn the clock back ten years we used generic codes for diagnostic tests so you may find a DEXA recorded incorrectly)
  • A number of practices have also found the osteoporosis was not coded just the scan.

Looking at QOF the majority practices have managed to identify patients, the average range is between 1 – 14 patients. I spoke to a practice with 11000 patients yesterday and they have 2 patients. The hardest is ensuring the coding is correct for fractures. This is where the admin staff need clinical input as not all fragility fractures are clear on the discharge letters.

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