Creating a cut-down list
The 2012 new business rules added new levels of complexity with the addition of the three MRC questions requirement to ‘score’ the Asthma review indicator (Asthma 9).
Each of the three questions can be ‘answered’ using one of a large range of Read codes, but some might consider the range of coding options to be unnecessarily complex and add little to the practical management of their asthmatic patients.
At our practice, we’ve decided to just use six from the list of options and then to use appropriate free text to further clarify, if needed:
Suggested ‘cut–down’ list of valid RCP Asthma codes:
One each from each of these pairs:
663N. Asthma disturbing sleep
663O. Asthma not disturbing sleep
663q. Asthma daytime symptoms
663s. Asthma never causes daytime symptoms
663e. Asthma restricts exercise
663f. Asthma never restricts exercise
Doing an asthma review
The original 23 options had five new options added in Version 23.0 of the Business rules in the middle of 2012, leading to the possibility that practices using those new codes may be ‘failing’ Asthma 9 if the analysis software is not yet using the latest version of the business rules. Each MRC question must be answered separately with a single valid Read code, together with coding the completion of the asthma review, using a valid asthma review code. All these four codes must be added on the same day to qualify for Asthma 9.
As regards the requirements for the asthma review itself, the blue guidance booklet (QOF Guidance for PCOs and Practices, 2012-13) states that the following should take place:
- assess symptoms (using the three RCP questions)
- measure peak flow
- assess inhaler technique
- consider a personalised asthma plan.
Practices might want to consider trying to record as many of these parameters as reasonably practical during asthma reviews, in case the PCT or CCGs decides to look critically at what degree of completeness is being achieved in such reviews.
Checks for eight-year-old patients
Many practices get confused by the peak flow requirements for asthmatic patients who are turning eight years old. Providing the diagnosis of Asthma was made after 1.4.2006, these children suddenly drop into the denominator for Asthma 8 (requirement to do spirometry or peak flow measurement). Such children need to have had a valid peak flow code added once ever. (This counts even if they had this done when they were younger than 8, although it only helps your QOF scores once the child turns eight-years-old).
Patients with COPD
Finally, I still get questions about whether a patient with COPD can also have asthma, or vice versa. Since 2006, it has been permissible to include a patient on both the Asthma and the COPD register, and this is explicitly sanctioned on page 97 of this year’s guidance document.
Top tips for coding asthma
- Decide as a practice how you will record the MRC question responses and consider whether a cut-down list (as demonstrated) is sufficient.
- Ensure that all your clinicians know that they must record an asthma review Read code on the same date that the MRC question codes are added.
- Derive a list of asthmatic children who will be turning eight years old in this QOF year ensure they’ve had their peak flows validly recorded at least once during their lifetime.
- Remember: it is possible for a patient to be on both the COPD and asthma registers.
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.