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Data Quality and Coding

The first step in making sure your clinical data is accurate and your prevalence rates reflect the true picture in your practice is to review the latest Business Rulesets (currently Version 20, published May 2011). To see a list of the changes that affect data collection by clinicians, download the following document.

Published in Pulse on 14th June, Dr Simon Clay listed 10 Common Coding Errors that could be costing you cash. We have listed some of the ones we found interesting below. Click here to read the full article on the Pulse website.

Measuring cardiovascular risk

The codes for the primary prevention of cardiovascular disease in new cases of hypertension are relatively new, and can be a source of confusion.

You may think that any code for the Framingham risk score would be suitable, but 3888 (Framingham CHD 10-year risk) and 388R (Framingham CHD 10-year adjusted risk) are not valid codes as they are not cardiovascular risk scores.

The two editions of QRISK (QRISK and QRISK2) are valid, as are the JBS CVD and the Framingham CVD 10-year risk scores (662 chapter, 38DF, 38DP and 38DR codes respectively).

Stroke treatment

You can code a stroke in three ways – G61 (infarction), G64 (bleed) or G66 (stroke unspecified).

Only the first group get put into the denominator group for Stroke 12 (patient needs anti-platelet or anticoagulant).

If the person inputting the QOF data at your practice uses G66 codes for any cerebral infarctions the aspirin prescriptions will not count for you.

Also, if you use prompting software to help you start useful drugs on such patients, the software will not prompt you to consider aspirin because there is no infarction code present to trigger it

Dr Gavin Jamie has produced another excellent article on his website (GPContract.co.uk) which outlines the changes made to coding under Business Ruleset V19. (n.b. V20 is the latest, but there have not been many changes to coding issues). Some of the pertinent issues are replicated below, but it is definitely well worth the time to read through the whole article.

So what is new this time? It is of little surprise that it is in mental health where the biggest changes are. Most of the other changes to indicators were fairly simple. Where there are lots of new indicators here there are also lots of codes.

First up is recording of alcohol consumption. In general codes starting 136 count but there are some odd exceptions to this. Code 136 on its own with a quantity would be fine. Anything which says unknown does not count. There is a list of "bad" codes and some good equivalents below.

Codes not counted Codes which are counted
136W Alcohol misuse 136T Harmful alcohol use
136M Current non drinker 1361 Teetotaler
1369 Suspected alcohol abuse - denied 136S Hazardous alcohol use
136Y Drinks in morning to get rid of hangover  
136b Feels should cut down on drinking 136K Alcohol intake above recommended sensible limits

Another complex area is advice to women who are having advice about epilepsy and fertility. This applies to women who are between ages 18 and 55 inclusive at the end of the year. They require separate codes for contraception 6110, pre-conceptual 67IJ0 and pregnancy 67AF counselling. All three codes or their exception codes must be entered every year.