How to code cases of Covid-19
As part of our ongoing support for health and care professionals during the Covid-19 pandemic, PRSB is publishing new guidance to support information sharing in collaboration with NHS Digital.
Who is this guidance for?
This guidance has been developed by health and social care professionals for health and care professionals and should be used by anyone working in primary, community and secondary care settings to support recording Covid-19 related information in people’s care records. It is intended for use across the four nations of the United Kingdom.
Why are we providing this guidance?
Consistent use of Covid-19 related terms enables precise communication between health and care professionals and care settings, supports better monitoring and treatment, and provides an invaluable source of data for public health, research and planning. The more precise the Covid-19 related information, the more useful the data will be for preventing, treating and planning for future outbreaks and new pandemics.
This guidance covers terminology for recording Covid-19 information. There are 13 information categories including exposure to coronavirus, diagnosis and complications, test requests and results. It replaces previous releases by PRSB.
Where new terms relate specifically to Covid-19 they should be used. These new terms are not exhaustive and existing terms may be appropriate to use as well in the context of Covid-19. It is important to use the terms set out here when entering information in free text because these terms can be searched, easily coded and readily understood wherever information is shared between care professionals and settings.
Implementation of new terminology will vary between system suppliers. This information has been shared with system vendors who will be incorporating it into their systems; health and care professionals should refer to announcements by their local clinical information officer or IT team or contact them for more details.
Clinical coders will want to work closely with colleagues and their system suppliers to understand how to use these new terms (based on SNOMED CT) should be applied in the context of Covid19 so there is consistency whether coding to SNOMED or ICD-10. This will support public health, research and service planning and management.
PRSB expects this list of terms to evolve as we learn more about what information is needed to manage COVID-19. As new information emerges we will provide further updates via our regular communications and our website.
NHS Digital release of SNOMED CT codes for Covid-19
NHS Digital has issued revised SNOMED CT codes for Covid-19 and updated its guidance based on the new revisions. The release can be found here and further information about SNOMED CT codes for COVID-19 can be found in NHS Digital’s regular publication, SNAP update. Technical guidance to support incorporating pathology coding into clinical information systems in primary care is available here.
Source: Professional Record Standards Body, Guidance for information sharing between health and care professionals [updated 21 May]