Codes for FEV1 (Added in last 15 months)
- 33971 Forced expired volume in 1 second percentage
change (v17)
3398. FEV1/FVC ratio normal
- 3399. FEV1/FVC ratio abnormal
- 339M. FEV1/FVC ratio
- 339O. Forced expired volume in 1 second
339O0 Forced expired volume in 1 second reversibility
(v17)
- 339R. FEV1/FVC percent
- 339S. Percent predicted FEV1
- 339T. FEV1/FVC > 70% of predicted
- 339U. FEV1/FVC < 70% of predicted
- 339a. FEV1 before bronchodilation
- 339b. FEV1 after bronchodilation
- 339e. FEV1 pre steroids
- 339f. FEV1 post steroids
- 339j. FEV1/FVC ratio pre steroids
- 339k. FEV1/FVC ratio post steroids
- 339l. FEV1/FVC ratio before bronchodilator
- 339m. FEV1/FVC ratio after bronchodilator
- 339S0 Percentage predicted forced expiratory volume
in 1 second after bronchodilation (v18)
COPD Codes
- H3... Chronic obstructive pulmonary disease
- H31.. Chronic bronchitis
- H310. Simple chronic bronchitis
- H3100 Chronic catarrhal bronchitis
- H310z Simple chronic bronchitis NOS
- H311. Mucopurulent chronic bronchitis
- H3110 Purulent chronic bronchitis
- H3111 Fetid chronic bronchitis
- H311z Mucopurulent chronic bronchitis NOS
- H312. Obstructive chronic bronchitis
- H3120 Chronic asthmatic bronchitis
- H3121 Emphysematous bronchitis
- H3123 Bronchiolitis obliterans
- H312z Obstructive chronic bronchitis NOS
- H313. Mixed simple and mucopurulent chronic bronchitis
- H31y. Other chronic bronchitis
- H31y1 Chronic tracheobronchitis
- H31yz Other chronic bronchitis NOS
- H31z. Chronic bronchitis NOS
- H32.. Emphysema
- H320. Chronic bullous emphysema
- H3200 Segmental bullous emphysema
- H3201 Zonal bullous emphysema
- H3202 Giant bullous emphysema
- H3203 Bullous emphysema with collapse
- H320z Chronic bullous emphysema NOS
- H321. Panlobular emphysema
- H322. Centrilobular emphysema
- H32y. Other emphysema
- H32y0 Acute vesicular emphysema
- H32y1 Atrophic (senile) emphysema
- H32y2 MacLeod's unilateral emphysema
- H32yz Other emphysema NOS
- H32z. Emphysema NOS
- H36.. Mild chronic obstructive pulmonary disease
- H37.. Moderate chronic obstructive pulmonary disease
- H38.. Severe chronic obstructive pulmonary disease
- H39.. Very severe chronic obstructive pulmonary disease
- H3y.. Other specified chronic obstructive airways disease
- H3y0. Chronic obstructive pulmonary disease with acute lower respiratory
infection
- H3y1. Chronic obstructive pulmonary disease with acute exacerbation,
unspecified
- H3z.. Chronic obstructive airways disease NOS
Exclusion codes (Every 15 months)
- 9h5.. Exception reporting: COPD quality indicators
- 9h51. Excepted from COPD quality indicators: Patient unsuitable
- 9h52. Excepted from COPD quality indicators: Informed dissent
COPD 10.1 Rationale
There is a gradual deterioration in lung function in patients
with COPD. This deterioration accelerates with the passage of time. There are
important interventions which can improve quality of life in patients with severe
COPD. It is therefore important to monitor respiratory function in order to
identify patients who might benefit from pulmonary rehabilitation or continuous
oxygen therapy.
NICE clinical guideline 101 recommends that FEV1 and inhaler technique
should be assessed at least annually for people with mild/moderate/severe COPD
(and in fact at least twice a year for people with very severe COPD). The purpose
of regular monitoring is to identify patients with increasing severity of disease
who may benefit from referral for more intensive treatments/diagnostic review.
Further information
NICE clinical guideline 101 – see table 6.
Practices should identify those patients who could benefit from
long term oxygen therapy and pulmonary rehabilitation.
These measures require specialist referral because of the need
to measure arterial oxygen saturation to assess suitability for oxygen therapy,
and the advisability of specialist review of patients prior to starting pulmonary
rehabilitation.
The long term administration of oxygen (more than 15 hours per
day) to patients with chronic respiratory failure has been shown to increase
survival and improve exercise capacity.
Referral for consideration for long term oxygen therapy and/or
pulmonary rehabilitation should be made to those with appropriate training and
expertise. This may include a respiratory physician, a general physician or
a GP with a special interest (GPwSI) in respiratory disease. The specific clinical
criteria for referral for long term oxygen therapy and pulmonary rehabilitation
are set out in NICE clinical guideline 101.
COPD 10.2 Reporting and verification
The practice reports the percentage of patients on the COPD register
who have had spirometry performed in the preceding 15 months.
In verifying that this information has been correctly recorded,
a number of approaches could be taken:
1. inspection of the output from a computer search that has been
used to provide information on this indicator
2. inspection of a sample of records of patients with COPD to
look at the proportion with spirometry results in the last two years
3. inspection of a sample of records of patients with COPD for
whom a record of spirometry is claimed, to see if there is evidence of this
in the medical records.
Prepared By Jean Keenan