Coding guidance for practices

National cardiovascular disease (CVD) prevention and risk factors toolkit

Context

This guidance aims provide GP practices who sign up for the Proactive and Preventative Care Cardiovascular Disease GP Enhanced Service (PPC CVD DES) with guidance on the codes to use to achieve automated payment for the Item of Service fee part of the DES.

Bundle of CVD checks

Blood Pressure

GPs and their teams should record blood pressure using the usual data entry templates or structured data area used in their system, the following codes will be automatically detected by the reporting system.

Read code Term code Term
246.. 00 O/E - blood pressure reading
246.. 11 O/E - BP reading
246.. 12 O/E- blood pressure
2469. 00 O/E - Systolic BP reading
246A. 00 O/E - Diastolic BP reading
246C. 00 Lying blood pressure reading
246D. 00 Standing blood pressure reading
246E. 00 Sitting blood pressure reading
246N. 00 Standing systolic blood pressure
246P. 00 Standing diastolic blood pressure
246Q. 00 Sitting systolic blood pressure
246R. 00 Sitting diastolic blood pressure
246S. 00 Lying systolic blood pressure
246T. 00 Lying diastolic blood pressure
246V. 00 Average 24 hour diastolic blood pressure
246W. 00 Average 24 hour systolic blood pressure
246X. 00 Average day interval diastolic blood pressure
246Y. 00 Average day interval systolic blood pressure
246Z. 00 O/E-blood pressure reading NOS
246a. 00 Average night interval diastolic blood pressure
246b. 00 Average night interval systolic blood pressure
246c. 00 Average home diastolic blood pressure
246d. 00 Average home systolic blood pressure
246e. 00 Ambulatory systolic blood pressure
246f. 00 Ambulatory diastolic blood pressure
246g. 00 Self measured blood pressure reading
246l. 00 Average systolic blood pressure
246m. 00 Average diastolic blood pressure
315B. 00 Ambulatory blood pressure recording

 

Total cholesterol and HDL cholesterol

It is expected that existing automated laboratory coding for these blood tests will provide evidence that the appropriate tests have been undertaken the automated reporting looks for the following codes.

Read code Term code Term
44OE. 00 Plasma total cholesterol level
44P.. 00 Serum cholesterol
44P9. 00 Serum cholesterol studies
44PH. 00 Total cholesterol measurement
44PJ. 00 Serum total cholesterol level
44PK. 00 Serum fasting total cholesterol
44PZ. 00 Serum cholesterol NOS

 

BMI

Whilst height and weight are needed to calculate BMI, it is only the BMI that will be detected for reporting and achievement purposes, GPIT systems have existing data entry templates or structured data area, that support this calculation and GPs should use these. Reporting looks for the presence of the following code with a value.

Read code Term code Term
22K.. 00 Body Mass Index

 

Smoking

Please use the smoking coding that exists on your system from the Quality and Outcomes framework. The DES recognises all these codes.

 

Risk scores

Diabetes UK risk score

GPs and their teams are asked to assess the patient and calculate a Diabetes UK Risk of Type 2 Diabetes Score to do get a risk score the following data items are needed:

Read code Term code Term
229.. 00 O/E – height
22A.. 00 O/E – weight
22N0. 00 Waist circumference

However, achievement is only measured against the presence of the following code with a value.

Read code Term code Term
38Gv. 00 Diabetes UK diabetes risk score

 

Diabetes testing

Where the T2DM Risk Score is high (equal or greater than 16). There is a requirement to undertake blood testing to assess for diabetes it is preferred that this is an HbA1c, but the achievement rules do accept a fasting blood glucose to allow for variation in local board policy around diabetes screening. It is expected that existing automated laboratory coding for these blood tests will provide evidence that the appropriate tests have been undertaken the automated reporting looks for the following codes.

Hba1c

Read code Term code Term
44TB. 00 Haemoglobin A1c level
42W.. 00 Hb. A1C - diabetic control
42W.. 11 Glycosylated Hb
42W.. 12 Glycated haemoglobin
42W4. 00 HbA1c level (DCCT aligned)
42W5. 00 Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised
42WZ. 00 Hb. A1C - diabetic control NOS

Fasting blood glucose

Read code Term code Term
44T2. 00 Fasting blood sugar
44TK. 00 Fasting blood glucose level
44f1. 00 Serum fasting glucose level
44g1. 00 Plasma fasting glucose level

 

ASSIGN CVD risk scoring

Practices should either use the Right Decision Service ASSIGN v2.0 risk calculator or (until the ASSIGN v2.0 codes are available in GP systems) the embedded ASSIGN v1.5 calculator on their GPIT System (Vision+ or BlueBayCT), where no embedded calculator is available GMS Facilitator teams can provide an offline version of the ASSIGN v1.5 calculator. The codes that should be used are as follows (recognising that ASSIGN v2.0 codes are unique to the GPIT system in use).

ASSIGN V2.0

Code Term GPIT System
38D61 ASSIGN version 2.0 score VISION3
^ESCT1593390 ASSIGN version 2.0 score EMIS PCS

ASSIGN V1.5

Read code Term code Term
38D6. 00 Assessing cardiovascular risk using Scottish Intercollegiate Guidelines Network score
38D6. 11 ASSIGN score

 

Patient discussion

A key part of the DES is that a member of the GP Practice team undertakes follow up with the patient to discuss the risk score; this should be captured by adding the following codes during a consultation.

  • 9OhA. Cardiovascular disease risk assessment done
    • Then if the value of the ASSIGN Risk Score is HIGH (ASSIGN V1.5 >=20 or ASSIGN V2.0 >=10)
  • 6C2.. Primary prevention of cardiovascular disease
    • Alternatively, if the ASSIGN Risk Score is LOW (ASSIGN V1.5 < 20 or ASSIGN V2.0 <10)
  • 67H.. Lifestyle counselling

Payment is predicated on having BOTH the “Cadiovascular disease risk assessment done” code and the appropriate one of the subsequent codes depending on the ASSIGN score result.