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GPs ‘need urgent advice on COPD severity coding’

By Nigel Praities

GPs run the risk of upsetting patients and causing confusion unless the rules over recording the severity of COPD are immediately clarified, say experts.

The warning comes after guidelines from NICE recommended GPs use a different classification system to record the severity of patients with COPD, clashing with the system currently used in the majority of practices.

Patients are categorised as having mild, moderate or severe COPD according to airflow obstruction, or FEV1, (using the H36-38 codes) but the new NICE guideline recommends a move towards a more complex system of classification, such as the internationally accepted system GOLD.

In a letter published in the journal Thorax this month, GP experts say a move to a new classification system will result in a change in the severity of disease recorded for some patients, but this will cause problems for practices and could upset patients.

‘Action is required now to address both the coding and communication issues so that sensible advice from NICE can be implemented without causing confusion in primary care and distress to patients,’ says the letter, with signatories including GP and NICE adviser Dr Kevin Gruffydd-Jones.

QOF currently incentivises practices to conduct an assessment of breathlessness using the MRC dyspnoea score, and this could be a way of temporarily replacing the current markers for disease severity, said the experts.

‘In future COPD severity codes should be based on multicomponent indices, at present a suitable index for primary care has not been chosen,’ they said.