With impressive speed version 19 of the business rules has been released. This is likely because rules are developed alongside the indicators at the NICE committee stage. The sign off date for this set of rules is given as December last year. This certainly makes things easier for practices and, perhaps because of the extra time, the rules seem pretty well put together and well annotated.
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.
There is, however, some chance of patients getting off the mental health register for the first time. Strangely this is not through the 212T resolved code but through remission codes for individual diagnoses. These are spread around read codes and all state remission rather than resolved. The implication that once you have mental illness it is never really gone remains. Use of these codes does not reduce disease prevalence for a practice.
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 |
The guidance states that lipids test must be for a TC:HDL ratio - this is certainly not the routine in my area. Even worse the only code currently allowed is 44PG HDL:TC ratio. This is the inverse of what the guidance asks for. Our lab certainly reports 44PF which would be the correct code here. This is clearly silly and I would hope that this would be corrected in the next version.
The codes for other areas of mental health are fairly routine. Glucose testing is not required for patients who have a diagnosis of diabetes although the test is still counted if they are diagnosed during the year. The sample can be fasting or random.
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. Useful information available from Epilepsy Action including a pdf leaflet (top right corner). Beware the "printer friendly" is a tree unfriendly 61 pages long!
Diabetes foot risk assessment is fairly straightforward using codes 2G5E-L. The rules are made a little more complex as they exclude bilateral amputees but this should not cause too much concern to practices. Just remember that they still need sensation testing (29B4-9 or 29H4-B) as well.
CHD 13 is the indicator that says new angina patients should be referred for specialist assessment. Excercise testing is not longer required, or counted. Referral codes 8H44, 8H4R, 8HTJ and 8HVJ count. Unfortunately NICE says that barn door angina does not need specialist assessment so exceptions will apply. There is no specific exception code so they would need 9h01 (excepted from CHD indicator, patient unsuitable) to be used. This is less than satisfactory. I would hope this would be sorted on the next release or they will requiring excepting from the whole of the CHD section every year.
Effectively the referral needs to be within 3 months before or after the diagnosis although within the same QOF year following diagnosis is also fine.
That is about the most I can spot at the moment. Most of the other indicators have changed in fairly minor or predictable ways. It is to be hoped that the obvious errors will be corrected soon, indeed it may be that version 19 is never actually implemented if version 20 comes out soon. The real message at the moment is to get cracking on the mental health checks and the epilepsy advice.
(Apologies if you have seen this post up and down over the last couple of days. Blogger crashed in a fairly major way and they had to get this from backup.)
