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10 tips for QOF coding

Every practice must maximise its QOF score but the coding rules change constantly. Dr Gavin Jamie provides an update on the latest requirements

By Dr Gavin Jamie

Every practice must maximise its QOF score but the coding rules change constantly. Dr Gavin Jamie provides an update on the latest requirements

The QOF is hard work. Its targets are a constant presence, reminding you about smoking, cholesterol or blood pressure.

It would be very disappointing if this work was not recognised when it came to adding up the points.

Rules are published about twice a year detailing the codes that will be used to collect data for QOF points. System suppliers then use these to create what you see on your system.

The tips in this article are based on version 15, which was published in September and should appear on practice systems in the next few months.

1 Assessment of new hypertensives

For patients who have been diagnosed with hypertension since 1 April 2009 there are two new requirements. First, for the under-75s, a CHD risk assessment is required face to face within a month. Estimated risks are not allowed. Effectively this means all patients require a HDL-total cholesterol ratio measurement. The actual calculation can be JBS/Framingham 38DR or 662k-662n or QRisk2 38DF. The latter is more accurate but more complex to apply.

Lifestyle advice must also be given to all patients within a year. The guidance says this must be on exercise, alcohol, smoking and diet. The rules only check that one of these, coded under 67H, has been entered, although this may change.

None of this applies to patients with previous CHD, stroke, TIA, peripheral vascular disease, diabetes, chronic kidney disease (stages 3-5 only) or familial hypercholesterolemia. Could it possibly be more complicated?

2 Depression – second questionnaire

Also new this year is the requirement for a second depression assessment between five and 12 weeks after the first – for instance, with a PHQ-9.

If you are behind on this, don't panic. There is a chance to catch up. According to the current rules, patients with a first recorded depression after 9 December this year will count towards this indicator with two assessments. Those with only one assessment will not count against you.

So you will be guaranteed 100% for the last 16 weeks of the year. But note this loophole may close before the end of this year.

3 Current non-smoker

One of the most useful smoking statuses has been dropped for this year. The code ‘current non-smoker – 137L' no longer counts. This applies both to Records 22 and Smoking 1. Patients must either be current smokers, ex-smokers or be recorded as having never smoked tobacco. This could be a shock to practices when the new rules arrive on the system, so ensure your templates no longer include that code.

4 Stopping coding non-smokers

Patients with three consecutive years of non-smoking do not have to be coded. Unfortunately, if any of these were coded as 137L (and nothing else) you need to start coding them again.

Don't forget if you get to the three years, miss a fourth and then code in the fifth you need to start all over again to build up three years. Only record when it is required.

5 Dyspnoea assessment

Don't forget to record the severity of COPD. This uses the MRC scale, which is narrative and easy to use. 173H - L are the required codes. The code descriptions are not particularly informative, but in their favour they are based on a narrative functional assessment.

6 Diabetes diagnosis

It is important that all your patients with diabetes are recognised by the QOF system as there are a lot of points in diabetes. Before 2006, the codes C108 and C109 and their child codes were commonly used for diabetes types 1 and 2. Since then the only codes recognised have been C10E and C10F. These can have identical descriptions, so do check you are using the right one for all patients with diabetes.

7 Mental health exclusions

Recovery from mental illness is not catered for in the mental health rules. Thus after a single psychotic episode the QOF demands a mental health review and care plan for life. As this is obviously inappropriate in many cases exception codes need to be applied every year. I use 212T (psychosis, schizophrenia and bipolar disorder resolved) internally in the practice as a reminder of which patients need the exception code 9h9. The code 212T is not a recognised QOF exception.

8 Mental health DNAs

Bizarrely, at least one patient on the mental health register has to miss a review appointment for a practice to claim the three points available. For safety's sake it is worth having at least two patients miss appointments, just in case one leaves the practice before the end of March.

On a more sensible note, it is important to make sure the DNA is recorded (9N4t) and so is the follow-up – 6A60. The follow-up can be as simple as phoning the patient or their mental health team member.

9 Long-acting contraceptive

‘Long-acting good, short-acting bad' is the theme of this new indicator. Every woman requesting oral contraception should be told of the virtues of long-acting contraceptives and then coded with 8CAw. Many systems did not have this code at the start of the year, so change the temporary codes if you have used them, or review consultations to see if advice was given. The guidance says written information should be given and this can be coded with 8CEE, although this is not a recognised QOF code.

10 Seasonal flu vaccinations

It has probably not escaped your notice that there are a lot of flu vaccinations this year. There are special codes for pandemic flu vaccinations, but no code for seasonal flu vaccination. The QOF, as the rules currently stand, cannot tell them apart. In fact, it may be hard for your own searches to tell them apart as well.

I have used a local code for seasonal flu vaccination, although the powers-that-be hate local codes. An alternative would be to use ZV048 for seasonal flu, which does not have pandemic child codes.

Dr Gavin Jamie is a GP in Swindon and runs the QOF Database website

MRC Scale of COPD severity QOF coding QOF coding

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