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Importance of episode codes

Ignore episode codes at your peril for you will lose money, explains Dr Simon Clay

Ignore episode codes at your peril for you will lose money, explains Dr Simon Clay

Q Can you explain why episode codes are important in the quality framework?

A Episode codes are additional, optional pieces of data that can be added to diagnostic codes to clarify their place in the patient's history. Examples are 'new', 'first', 'ongoing' and several others.

In five areas of the QOF – depression, stroke, chronic heart disease, myocardial infarction, chronic kidney disease and cancer – the episode code is also considered when analysing the patient's disease code. In these diseases, the software will consider only the latest added Read code that has been episode-coded 'first' or 'new'.

For cancer, only codes added from 1 April 2003 are considered. For the other diseases, there is no earliest time limit.

If no episode code of 'new' or 'first' is added (and many practices don't bother), your QOF analysis software is programmed to focus on the first valid code in the particular disease in question, unless it is explicitly episode-coded 'ongoing'. This affects whether the recent diagnosis is seen at all by the software and also affects whether codes dependent on these diagnoses are seen – for example, cancer review codes, the scan requirement in stroke and the need to be on ACE inhibitors with CKD and MI.

Let's look at the implications of this rule with depression. A patient consults you today. You add a depression code and the patient completes a PHQ-9 questionnaire, which you also add. If this is the first depression code ever, all will be well.

But if the patient had depression in 2005 and this is recorded on your clinical system, failing to add an episode code today will cause the more recent depression code to be ignored in favour of the first recorded occurrence. The software won't add the patient to your depression register for this year and the PHQ-9 coding will also be ignored.

But simply add an episode code of 'first' or 'new' to today's depression code and the patient will be added to the depression cohort for this QOF year and the PHQ-9 will count for you.

Knowledge of episode codes increases disease prevalence and makes all your hard work count. Ignore them and you will lose money.

Dr Simon Clay is a GP in Birmingham

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