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Last-minute QOF tips: CVD primary prevention, 2012-13

Dr Simon Clay covers ‘catches’ in the QOF business rules 2012-3 for CVD primary prevention (CVD-PP), to help practices avoid missing out on valuable points

This month I’m looking how to score well on the CVD-PP indicator.

For CVD-PP1, new hypertensives aged 30-74 (excluding those who have already been coded as having any one of CVA, DM, CHD, CKD grade 3-5, PVD or Familial Hypercholesterolaemia) need a single CVD Risk score adding once only within 3 months either side of the date of diagnosis.

The seven code chapter options are:

  • 662k-n (JBS CVD risk score)
  • 38DF (QRISK CVD 10 year risk score)
  • 38DP (QRISK2 cardiovascular disease 10 year risk score)
  • 38DR (Framingham 1991 CVD 10 year risk score)
  • 38B10 (CVD risk assessed by a third party)
  • 38G6 : Joint British Societies cardiovascular disease risk score (Version 23)
  • 38G8 : Dundee CVS risk score (Version 23, October 2012)

No other Framingham scores (for example, 3888 Framingham CHD 10-year Risk, or 388R Framingham CHD 10 year Adj risk) are permitted, except those above. Note that patients also need Tot’ Cholesterol, HDL-C, Smoking status, DM status and LVH status in order to calculate their Risk score.

For QRISK2, they also need Ethnicity, Family Hx of CHD if present and postcode.

Ensure that patients newly-diagnosed as hypertensive have appropriate bloods, relevant demographic data added and an ECG done during the background investigations - otherwise you can’t accurately calculate the scores.

For CVD-PP2, new hypertensives need to receive annual advice on related lifestyle issues (smoking, diet, exercise and alcohol). The only permitted valid codes are 67H or 67H8 (‘lifestyle advice regarding hypertension’, valid since Version 16.0 of Ruleset, December 2009). The time ‘window’ for the addition of this code is within the previous 15 months before each Reference date.

Top tips for coding CVD-PP

  1. Get your clinicians to do routine bloods, including HbA1c, Lipids and HDL, together with Smoking status and ECG as they diagnose hypertension, or, even better, during the ‘work-up’ investigations, so the CVD risk score can be promptly added early in the process of early investigation and treatment.
  2. Any one of six pre-existing diagnoses exempt the patient from having a CVD risk score added: CHD, DM, CVA/TIA, PVD, Familial Hypercholesterolaemia and CKD 3-5.
  3. Lifestyle advice is required to be given & re-given annually. (Note the only two valid codes for doing this.) Many others in the same chapter are non-valid.
  4. A final drive to collect missing lifestyle advice data in January to March each year scores twice over, as these Read codes will still be valid the following QOF year.

Next month, Dr Clay will be covering tips for coding CVD care. For information on Dr Clay’s QOF resources, go to http://tinyurl.com/dy9cea8

Dr Simon Clay is a GP in Erdington, Birmingham.

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