Q&A

: We asked a professor of Renal Medicine and the answer received was as follows:

 

I think the reasons for repeat testing of MA in DM even after establishing its presence are:

– In 30% of T1DM at least (T2DM less clear) MA will regress and disappear

– In some patients MA progresses to macroalbuminuria

Both of these events have implications for a patient’s renal function in the long term – one good, one bad – so probably some merit in knowing what’s happening in order to keep patient informed and health care staff on their toes in dealing with other modifiable risks as appropriate.

Yes the patients require a test to identify those DM patient who have a diagnosis of either nephropathy (clinical proteinuria) or micro albuminuria but the indicator itself is only looking for those patients with confirmation of nephropathy (clinical proteinuria) or micro albuminuria who are currently treated with an ACE or ARB, not those who have had the test done and are negative. I have checked two practices and for example one practice had 222 patients on their register of which only 59 appear in DM006 as they are the only ones with a confirmed diagnosis and of the 59 patients the practice has achieved the indicator for 52 patients as they are currently being treated with an ACE-I or ARB.

The exception code for patients who have declined to give a urine specimen

CTV3                   Version 2

Xaa3v                     9RX..               Declines to give urine specimen

Hospital cared DM patients cannot be excluded because the clinic did not review those areas of care.  If you find they have had all the care with the exception say for example their foot check. I would suggest you send a letter stating ‘you are aware they have had their annual review at the hospital but it would appear that their feet were not check’. Explain the importance of it in the body of the letter and then ask if they would make a ten minute appointment with the appropriate nurse/HCA. You will receive a  far better response than sending a generic letter

 

The new Read Codes are listed below with the conversion table:

International Federation of Clinical Chemistry (IFCC) Standardization of HbA1c conversion table

 

IFCC HbA1c NGSP HbA1c (%)
31 5
42 6
53 7
64 8
75 9
86 10
97 11
108 12

 

Version 2

42W5.   Haemoglobin A1c level – International Federation of Clinical Chemistry and Laboratory Medicine standardised

 

CTV3

XaPbt    Haemoglobin A1c level – International Federation of Clinical Chemistry and Laboratory Medicine standardised

It is recommended you still discuss the three topics with patients as CQRS are extracting this data. Although the results will not be used to assess practice achievement

CTV3                      Version 2

XaRFa                    8IB4.                     Pregnancy advice for patients with epilepsy not indicated

XaRFb                   8IB3.                     Pre-conception advice for patients with epilepsy not indicated

XaRFc                    8IB2.                     Contraceptive advice for patients with epilepsy not indicated

To achieve this indicator you would need to have patients diagnosed with proteinuria or micro-albuminuria that you would treat with an ACE inhibitors (or A2 antagonists). If you are aware of patients with a diagnosis of either proteinuria or micro-albuminuria, you need to check the Read Codes used.

 

 

Both codes are part of QOF so there is not an issue there and both results have been sent by the lab for about a year now. The 42W5 being the International Federation of Clinical Chemistry and Laboratory Medicine standardised and the more familiar code 42W4.HbA1c level (DCCT aligned)

 

We should be working towards familiarising ourselves with the new levels although there has not been any change to the rule sets regarding the 42W4, this is still acceptable at the moment

 

Comparing DCCT-HbA1c and IFCC-HbA1c Results

 

The chart below allows the practices to convert the levels and I would be surprised if practices did not have a copy, we did hand them out to the audit clerks last year

 

 

 

 

DCCT-HbA1c (%)             IFCC-HbA1c (mmol/mol)

6                                                              42

6.5                                                          48

7                                                              53

7.5                                                          59

8                                                              64

9                                                              75

 

You need to check the Read code used to record the amputation is a QOF code.

 

Foot Amputation Codes
  CTV3 Version 2
O/E – Amputated right leg XaBLT 2G42.

 

 

 

  CTV3 Version 2
O/E – Amputated right above knee XaBLV 2G44.
O/E – Amputated right below knee XaBLX 2G46.
O/E – Amputated left leg XaBLU 2G43.
O/E – Amputated left above knee XaBLW 2G45.
O/E – Amputated left below knee XaBLXY 2G47.

 

 

Version 2 ( EMIS, Vision, Microtest and Torex)

C10.. Diabetes mellitus

C109K Hyperosmolar non-ketotic state in type 2 diabetes mellitus

C10C. Diabetes mellitus autosomal dominant

C10D. Diabetes mellitus autosomal dominant type 2

C10E. % Type 1 diabetes mellitus

C10F.% Type 2 diabetes mellitus (Excluding C10F8)

C10G.% Secondary pancreatic diabetes mellitus

C10H.% Diabetes mellitus induced by non-steroid drugs

C10M.% Lipoatrophic diabetes mellitus

C10N.% Secondary diabetes mellitus

 

CTV3 (SystmOne)

C10.. Diabetes mellitus

XaOPu Latent autoimmune diabetes mellitus in adult

XaOPt Maternally inherited diabetes mellitus

X40J4% Type 1 diabetes mellitus

X40J5% Type 2 diabetes mellitus (Excluding C10F8)

X40J6 Insulin treated Type 2 diabetes mellitus

X40JA % Secondary diabetes mellitus

X40JG% Genetic syndromes of diabetes mellitus

C1011 Type 2 diabetes mellitus with ketoacidosis

C1010 Type 1 diabetes mellitus with ketoacidosis

 

 

C1030 Type 1 diabetes mellitus with ketoacidotic coma

C1031 Type II diabetes mellitus with ketoacidotic coma

XaIrf Hyperosmolar non-ketotic state in type II diabetes mellitus

 

X40JZ Diabetes-deafness syndrome maternally transmitted

XSETp Diabetes mellitus due to insulin receptor antibodies

XM1Xk% Unstable diabetes

C10G.% Secondary pancreatic diabetes mellitus

C10H.% Diabetes mellitus induced by non-steroid drugs

C10M.% Lipoatrophic diabetes mellitus

C10N.% Secondary diabetes mellitus

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