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Read code chaos in NICE COPD advice

The row over NICE COPD guidance took a new twist

as fresh problems emerged – Rob Finch reports

GPs have added to the criticism of NICE guidelines on chronic obstructive pulmonary disease, warning they are set to cause chaos over Read code classifications.

The General Practice Airways Group is concerned that NICE's definitions of severity (mild, moderate and severe) differ from British Thoracic Society and GOLD (Global initiative for Obstructive Lung Disease) definitions.

'This will cause considerable confusion when auditing and researching primary care computer records based on the three Read codes H36, H37 and H38 used for mild, moderate and severe COPD,' the group said.

The criticisms come after a clash between NICE guidelines and quality and outcomes indicators for COPD forced the Department of Health to consider eleventh hour changes to the new contract.

Under current guidelines from the three specialist bodies (see below) definition of severity of COPD, judged by percentage of predicted forced expiratory volume (FEV1) varies widely: NICE and BTS levels vary by 10 per cent.

While NICE and GOLD agree on the FEV1 levels used to define severity, the two bodies disagree on the definitions of the categories.

Dr Grant Kelly, GPC member with an interest in IT, said that in spite of the apparent discrepancy, GPs would still get paid under the new contract because 'all the parent and daughter codes are swept up together to go towards quality pay'.

Dr Kelly, who practises in Chichester, said GPs would be free to make their own interpretations of the classifications: 'The Read code is the product of the patient encounter and the next GP's encounter with that patient may be different and the code will move on. You can't give the code more wisdom than the doctor'.

Dr David Halpin, who led the NICE guideline development group, said the GOLD guidelines were not directly relevant for UK practice because they were over-inclusive.

Dr Halpin, consultant physician at the Royal Devon and Exeter Hospital, said: 'Essentially the BTS guidelines have been revised rather than superseded – the changes are in the thresholds that determine what treatments are

relevant to those patient groups.'

Dr Halpin said that the FEV1 values in NICE guidance were now the same as international guidelines, even if the name given to those levels was different.

Coding is nonsense, says GP

Dr Angus Goudie has called for clear guidance on how to assess severity of COPD after the flaws in the NICE guidelines emerged.

Dr Goudie (above), a GP in Houghton le Spring, County Durham, said Read codes were 'meaningless' while the conflict existed.

Dr Goudie, a member of Sunderland PCT's dataset and clinical coding group, said: 'The new contract makes it essential to code things properly – the problem is that we need guidance on which code to use for which severity of COPD.

'At the moment we are coding it under "COPD not otherwise specified" and entering the FEV1 percentage in the free text. We should be using a specific code, not a parent code – it may be fussy but it's the modern meaning of the diagnosis. We want a code that means the same thing to all people – we assumed NICE would offer guidance.'

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