Read Dr Simon Clay's final article on coding for the QOF on depression and how to avoid writing mental health care plans.
Under QOF rules before April 2006, the only patients who were on the mental health register were deliberately put there by the active addition of one of two Read codes that defined the presence of a mental illness: 9H6 (on NSF mental health register) or 9H8 (on severe mental illness register). respectively).
Since December 2006, and in versions thereafter, the whole concept of a mental health register is abandoned in QOF. There is only a list of patients within the mental health denominator group (MH). There are now two different ways patients may end up on this group:
1. The presence of a ‘psychosis' Read code, as defined by the mental health ruleset, anywhere in the record and added at any time in the past
2. Having a script for lithium in the six months before each ‘reference date' (1 April each year)
The list of Read codes which will ‘trigger' inclusion into the list of patients who need a mental health review annually under the QOF is as follows:
• E10..%, E110.%, E111.%, E1124, E1134
• E114. – E117z
• E11y.% (excluding E11y2)
• E11z., E11z0, E11zz, E12..%,
• E13..% (excluding E135.)
• E2122, Eu2..%
• Eu30.%, Eu31.%
• Eu323, Eu333
The presence of any of these codes, added at any time in the patient's clinical record, even 30 years ago, now classifies the patient as being in the list of psychotic patients as far as the QOF is concerned.
Depression Read codes
The depression Read codes are roughly divided into a neurotic depression chapter and a psychotic depression chapter.
In the QOF rules as formulated in April 2006, if a GPs has previously added any depression read codes from the psychotic depression chapter, they were often accidentally defined as ‘psychotic' under the QOF rules and would therefore need a mental health care plan and a mental health review etc.
The rule changes introduced in version 9.0 (December 2006) and continued subsequently, resolve most of this complexity by removing many of the depression codes from the trigger list of psychosis codes that previously forced the patient into the MH group as well.
There are now only nine depression codes that also put the patient into the MH group as well. Luckily these all actually look like psychosis codes so it's unlikely GP's will use them accidentally. They are as follows:
• E1124 (single episode major depression with psychosis)
• E1134 (recurrent major depress' with psychosis)
• E130 (psychotic reactive depression)
• Eu204 [X] (post-schizophrenic depression)
• Eu251 [X] (schizophrenic psychotic depression)
• Eu323 [X] (single episode of psychotic depression)
• Eu333 [X] (recurrent psychotic depression)
• Eu328 : [X] (major depression, severe with psychotic symptoms)
• Eu333 [X] (endogenous depression + psychotic symptoms)
Once a psychosis code is added to the record, there is no easy way to remove the patient from the psychosis register under the MH disease category. The Read code 9H7 (removed from mental illness register) originally introduced for this purpose, no longer works under the new rules.
Valid depression code examples
‘Acceptable' codes (triggering only a "Depression" diagnosis under QOF), include:
• E135 (agitated depression)
• Eu32z (reactive depression)
• E2003 (anxiety with depression)
• E2B.. (depressive disorder)
• E112 (agitated or endogenous depression)
• Eu320 / Eu321 / Eu322 (mild/ moderate/ severe depression)
The following ‘sadness' codes are neither depression nor MH psychosis codes:
• 13Hc (bereavement)
• E2900 (bereavement reaction)
• Any .1 chapter ‘symptom' codes such as !BT.. (depressed mood)
Dr Simon Clay is a GP in Erdington, BirminghamDepression