Q&A

Over the counter medication should be re-coded annually to ensure that their situation has not changed. The Read codes are:

CTV3                      Version 2

XaFsi                        67I8.                    Advice about taking aspirin

XaF7N                     8B3T.                   Over the counter aspirin therapy

XE0hr                      8B63                    Salicylate prophylaxis

Use the available exception for Aspirin, other alternative anti-platelets and anti-coagulant if not tolerated. The system will look at all three areas as if the patient cannot take one therapy, the system will look for the prescribing of the other groups of therapies that are listed within the criteria.

 

Without seeing the patient’s records, this is difficult to answer. This could be due an old entry, in the past GPs would put ‘Angina’ then free text ‘query angina’ . It will be a case of searching back in the patient’s clinical record to find the entry and mark it in error if appropriate.

 

CKD diagnosis is to be based on a combination of two eGFR <60 and Albumin Creatinine Ratio (ACR) test results

NICE: Kidney function should be assessed using a combination of GFR and albumin: creatinine ratio (ACR) categories.  Increased ACR and decreased GFR are associated with increased risk of adverse outcomes.

Eating a meal containing high protein can elevate creatinine. It is therefore recommended that patients do not eat meat in the 12 hours before their creatinine is measured and eGFR estimated.

https://www.nice.org.uk/guidance/cg182/resources/classification-table-msword-191901277

In the past we have always recommended to practices to use the CKD 2 Read code to remove a patient from the QOF register. The HSCIC have released a resolve Read Code in the V32 Business Rules, once added it will remove the patient from CKD disease Register.

 

  V2 CTV3
Chronic kidney disease resolved 2126E XabuQ

You should be using  the following Read code. You need to add this code at the time of the MRC scale if =>3

V2:  44YA0    Oxygen saturation at periphery.

CTV3: X770D  Oxygen saturation at periphery.

COPD does not resolve which is why there is not a code available, once you are diagnosed with COPD then you have it. Do not forget the patient may have both Asthma and COPD as 15% are expected to have both diagnoses.

If not it would be inappropriate labeling so the action would be to correct the diagnosis.

The following code is a new exception code available for patients where they are unable to perform a spirometry

CTV3                                                                                                      V2

XaXlR Unable to perform spirometry                                       33720 Unable to perform spirometry

To achieve COPD 13 ‘a review in the preceding 12 months’, you will need to record both the review and the MRC dyspnoea score.

The criteria has changed for this year, the indicator wording is:

DEM004 (002): The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months – 39 points (35-70%)

If the patient has an advanced care plan in place from secondary care, this will be acceptable. For those patients who do not have a care plan, the practice will be required to develop an acceptable care plan.

The review of the patient care plan regardless of who has initiated the plan is a face to face review in primary care – you cannot use a hospital review to achieve this indicator.

The new Read codes are as follows:

V2 CTV3
Dementia advance care plan agreed 8CSA. XabEk
Dementia care plan 8CMZ. XaaBZ
Review of dementia advance care plan 8CMG2 XabEl
Dementia advance care plan declined 8IAe0 XabEi
Dementia advance care plan review declined 8IAe2 XacM2
Dementia care plan review declined 8CMZ3 XacJ0

 

A Face to face review:

The Face to Face care plan/Advanced care plan review should have the following key issues:-

An appropriate physical, mental health and social review for the patient

A record of the patient’s wishes for the future.

Communication and co-ordination arrangements with secondary care (if applicable), identification of the patient’s carer(s):

  1. Obtain appropriate permissions to authorise the practice to speak directly to the nominated carer(s) and provide details of support services available to the patient and their family, if applicable, the carer’s needs for information commensurate with the stage of the illness and his or her and the patient’s health and social care needs,
  2. As appropriate, the carer should be included in the care plan or advanced care plan discussions,
  3. If applicable, the impact of caring on the care-giver,
  4. Offer the carer a health check98 to address any physical and mental health impacts, including signposting to any other relevant services to support their health and wellbeing
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