Download Contract Specification changes v9 to v10

Contract Specification changes v18 to v21
Asthma
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V19 Minor changes to indicator wording only, not affecting meaning of
indicator.
V20 codes H333. (Acute exacerbation of asthma) and H33z1 (Asthma attack)
now included in diagnosis codes
V20 Drug list tidied to exclude discontinued drugs
V20 added code 745D4 (Post bronchodilator spirometry) to spirometry codes
V20 added code 33950 (Diurnal variation of peak expiratory flow rate) to
PEFR codes
Atrial Fibrillation
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V20 Minor changes to indicator wording only, not affecting meaning of
indicator
V21 added code 8HTy. Referral to atrial fibrillation clinic for AF4
Cancer
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Minor changes to indicator wording only, not affecting meaning of indicator
V20 New read code within current diagnosis code groups - B627E Diffuse
large B-cell lymphoma
CHD
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CHD 2 Removed (The percentage of patients with newly diagnosed angina (diagnosed
after 1 April 2003) who are referred for exercise testing and/or specialist
assessment). replaced by CHD13
New Indicator CHD 13: For patients with newly diagnosed angina (diagnosed
after 1 April 2011), the percentage who are referred for specialist assessment.
Codeset refined to only cardiology referral codes. Care needed as codes for
exercise tolerance testing are no longer accepted
V21 added code 8Htk. (Referral to community cardiology service)
Referral requires coding for patients with new angina after 1.4.11 and within 3
months before to 12 months after the angina diagnosis date
No exception coding for CHD13 (codes used for CHD2 removed)
V20 new code added to MI codes - Gyu36 [X]Subsequent myocardial
infarction of unspecified site
V20 added combination drug Hydrochlorothiazide + Olmesartan to A11 drug
searches.
CHD5 Removed (The percentage of patients with Coronary Heart Disease, whose notes
have a record of blood pressure in the previous 15 months ).
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CHD6 payment range now 40 – 71% (previously 40-70%)
CHD7 Removed (The percentage of patients with coronary heart disease, whose notes
have a record of total cholesterol in the previous 15 months).
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CHD11 Removed (The percentage of patients with a history of myocardial infarction
(diagnosed after 1.4.03) who are currently treated with an ACE Inhibitor or angiotensin II
antagonist). replaced by CHD14
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New Indicator CHD 14: The percentage of patients with a history of
myocardial infarction (from 1 April 2011) currently treated with an ACE
inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet
therapy, beta-blocker and statin (unless a contraindication or side effects are
recorded). Statin prescriptions count. A code for over the counter statins had
been added but now removed in V21. (8B3z. – “Over the counter statin therapy)
New codeset created for Statin prescribing specifically for CHD14. Exception
codes also added, the same as for Cholesterol measurements.
V20 - prescriptions for celvapan and pandemrix removed from the prescription
codeset.
CKD
 Minor changes to indicator wordings only, not affecting meaning of indicators
 V20 added combination drug Hydrochlorothiazide + Olmesartan to A11 drug
searches.
 V21 – codes added to hypertension diagnosis
Gyu2. [X]Hypertensive diseases
Gyu20 [X]Other secondary hypertension
Gyu21 [X]Hypertension secondary to other renal disorders
COPD
 COPD1 renumbered to COPD14 as changes to recommended diagnostic
threshold.
 COPD 15 (previously COPD12) date change so that post dilator spirometry
now required for new diagnoses after 1.4.2011.
 V19 significant changes to codesets. 33H%, 33I%, 33J%, 66Ta - 66Yb all
removed. V19 Now only 2 codes acceptable 8HRC. (Referral for spirometry)
and the newly added code 745D4 (Post bronchodilator spirometry). Care
needed to use correct codes
 V19 Spirometry exception codes - removed codes 8I2M. (Spirometry
reversibility testing contraindicated) and 8I6d. (Spirometry reversibility testing
not indicated)
 Minor changes to wording and numbering of some indicators. Not affecting
meaning of indicators
 V20 New codes added to the COPD review codes - 66YB0 (Chronic
obstructive pulmonary disease 3 monthly review) and 66YB1 (Chronic
obstructive pulmonary disease 6 monthly review)
 V20 New code added to FEV1 codes - 339O1 (Forced expired volume in one
second/vital capacity ratio)
 V20 - prescriptions for celvapan and pandemrix removed from the prescription
codeset.
 V21 New code added to Spirometry exceptions - 33720 (Unable to perform
spirometry)
CVD – Primary Prevention
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Changes to wording of indicators, adding in age ranges for PP1 so only
patients age 30 – 74 require CHD Risk assessment. Assessment required
within 3 months of diagnosis.
V21 – codes added to hypertension diagnosis
Gyu2. [X]Hypertensive diseases
Gyu20 [X]Other secondary hypertension
Gyu21 [X]Hypertension secondary to other renal disorders
V21 – PP1 change to the search so that code for hypertension now needs to be
after 1.4.09 AND be recorded as a latest first or new episode
V21 New code added to Hypercholesterolaemia codeset - C3205 (Familial
defective apolipoprotein B-100)
Dementia
 V19 New indicator - The percentage of patients with a new diagnosis of
dementia (from 1 April 2011) with a record of FBC, calcium, glucose, renal
and liver function, thyroid function tests, serum vitamin B12 and folate levels
recorded 6 months before or after entering on to the register.
 V19 - Specified codes for the blood test results – additions to these codesets
made in V20.
 V21 New codes added to liver function codes:44E.. Serum bilirubin level
44E9. Plasma total bilirubin level
44EC. Serum total bilirubin level
 V21 New code added to folate codes
42U4. Red blood cell folate
Depression
 Minor changes to wording and numbering of some indicators. Not affecting
meaning of indicators
 V21 Added code 68910 (Assessment using Whooley depression screen) for
Dep1 depression screening questions
 V21 Code excluded from ruleset – Eu32B ([X]Antenatal depression)
 Timing for second assessment changed fron 5-12 weeks to 4-12 weeks.
Indicator renamed to Dep5 (previously Dep3).
 Changes to points available for Depression indicators.
 Payment target range changes to 40-80% for Dep5.
Diabetes
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Targets for HbA1c changed to <=7.5, <=8, <=9 (or equivalent IFCC figures).
New indicators, DM26, DM27 and DM28 for HbQ1c measurements. Indicator
DM5, for HbA1c test removed to leave only those for target results.
Indicator for peripheral pulses, DM9, replaced with DM29, a record of foot
examination and risk classification.
Codes for amputaions of legs can be used to exception codes fromDM29 and
DM10, foot examination and neuropathy testing (need separate codes for both
legs).
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Adjustments made to exception codes for neuropathy testing and foot
examination/risk assessment. Care needed to use correct codes.
DM11 removed – testing of blood presuure, leaving only BP target indicators.
BP indicators changes to two separate indicators for target of <= 150/90
(DM30) and <=140/90 (DM31).
Indicator for cholesterol testing (DM16) removed leaving only for target of
<=5.0mmol/l.
V20 - prescriptions for celvapan and pandemrix removed from the prescription
codeset.
Epilepsy
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Minor changes to wording and numbering of some indicators. Not affecting
meaning of indicators
Epilepsy 7 removed ( medication review)
V19 New indicator - The percentage of women under the age of 55 years who
are taking antiepileptic drugs who have a record of information and
counselling about contraception, conception and pregnancy in the preceding
15 months. Exception codes available but care needed with coding
requirements for this indicator.
V21 Codeset for hysterectomy coding rewritten. (these codes exclude women
from V19)
Heart Failure
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Minor changes to wording of some indicators. Not affecting meaning of
indicators
Hypertension
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Minor changes to wording of some indicators. Not affecting meaning of
indicators
V21 New codes added for hypertension register
Gyu2. [X]Hypertensive diseases
Gyu20 [X]Other secondary hypertension
Gyu21 [X]Hypertension secondary to other renal disorders
Hypothyroid
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Minor changes to wording of some indicators. Not affecting meaning of
indicators
Learning Disabilities
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Minor changes to wording of some indicators. Not affecting meaning of
indicators
V19 New indicator LD 2: The percentage of patients on the learning disability
register with Down’s Syndrome aged 18 years and over who have a record of
blood TSH in the preceding 15 months (excluding those who are on the
thyroid disease register)
Mental Health
 Addition of codes for MH in remission. These will permanently remove the
patient from the MH register unless a subsequent MH code is added to their
record.
 V21 added new codes to Mental Health codeset
Eu318 – [X]Bipolar affective disorder type I
Eu319 – [X]Bipolar affective disorder type II
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Removal of MH9 which required coding of a Mental Health Review this has
been replaced by several more specific indicators :- MH11: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of alcohol
consumption in the preceding 15 months
- MH12: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of BMI in
the preceding 15 months
- MH13: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of blood
pressure in the preceding 15 months.
- MH14. The percentage of patients aged 40 years and over with
schizophrenia, bipolar affective disorder and other psychoses who have
a record of total cholesterol:hdl ratio in the preceding 15 months
- MH15: The percentage of patients aged 40 years and over with
schizophrenia, bipolar affective disorder and other psychoses who have
a record of blood glucose in the preceding 15 months.
- MH16: The percentage of patients (aged from 25 to 64 in England
and Northern Ireland, from 20 to 60 in Scotland and from 20 to 64 in
Wales) with schizophrenia, bipolar affective disorder and other
psychoses whose notes record that a cervical screening test has been
performed in the preceding 5 years.
For patients on Lithium, Creatinine and TFT now required within previous 9
months (used to be in last 15 months).
Lithium levels in therapeutic range require entry within previous 4 months
(used to be in last 6 months).
New information in Contract guidance as to what should be considered for a
care plan.
Removal of MH7 which required follow up within 2 weeks of patients who
DNA’s a mental health review.
Obesity
 Minor changes to wording of indicator. Not affecting meaning of indicators
Palliative Care
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Minor changes to wording of indicator. Not affecting meaning of indicators
V21 New code added to codeset
8IEE. Referral to community palliative care team declined
Records
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Ethnicity indicator removed
Minor changes to wording of indicators. Not affecting meaning of indicators
Sexual Health
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V20 new codes added for Contraception population (SH1)
61511 Insertion of T shaped 375 millimetres squared copper coated
intrauterine contraceptive device
61R.. Intrauterine system contraception
9kr.. Subdermal etonogestrel implant insertion enhanced services
administration
V20 new codes added for LARC advice given (SH2 and SH3)
679K2 Education for intrauterine system
8CAw1 Verbal advice about long acting reversible contraception
8CAw2 Written advice about long acting reversible contraception
V21 added new code for contraceptive implant insertion and removal
7G2AJ Insertion of etonogestrel radiopaque contraceptive implant
7G2HB Removal of etonogestrel radiopaque contraceptive implant
V21 added new codes for written advice given
8CEF. Intrauterine device contraception leaflet given
8CEG. Long acting reversible contraception leaflet given
Guidance stresses that both verbal and written information is required. If code
679K2 or 8CAw. (Advice about long acting reversible contraception) are used
then it is assumed both have been given. If codes 8CAw1 or 8CAw2 are used
the BOTH need to be entered to meet this indicator.
Smoking
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Minor changes to wording of indicators. Not affecting meaning of indicators
V21 New codes added for Smoking advice
8CdB. Stop smoking service opportunity signposted”
9OOB. Stop smoking invitation short message service text message
9OOB0 Stop smoking invitation first SMS text message
9OOB1 Stop smoking invitation second SMS text message
9OOB2 Stop smoking invitation third SMS text message
Stroke / TIA
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V20 excluded code G669. (Cerebral palsy, not congenital or infantile, acute)
from Stroke and TIA diagnosis codes
V20 added codes to the set for non-haemorrhagic stroke codes :G665. Pure motor lacunar syndrome
G666. Pure sensory lacunar syndrome
Gyu63 [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs
Gyu64 [X]Other cerebral infarction
Gyu65 [X]Occlusion and stenosis of other precerebral arteries
Gyu66 [X]Occlusion and stenosis of other cerebral arteries
Gyu6G [X]Cereb infarct due unsp occlus/stenos precerebr arteries
Stroke5 removed (requirement to measure Blood pressure)