COPD15

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Spirometry Exception codes - go to this
COPD Exclusion codes - go to this
COPD codes go to this
COPD Rationale - go to this

Spirometry codes for COPD (Must be done between three months before and up to twelve months after diagnosis (v12))

745D4 Post bronchodilator spirometry 8HRC. Referral for spirometry

Spirometry exception codes (Added in the last 15 months)

8I3b. Spirometry test declined
8I6L. Spirometry not indicated
8I2j. Spirometry contraindicated (v18) 33720 Unable to perform spirometry

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 15.1 Rationale

A diagnosis of COPD relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry.

NICE clinical guidelines provide the following definition of COPD:

airflow obstruction is defined as a reduced FEV1/FVC ratio (where FEV1 is forced expired volume in one second and FVC is forced vital capacity), such that FEV1/FVC is less than 0.7
if FEV1 is greater than or equal to 80 per cent predicted normal a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough.

The NICE guidelines require post bronchodilator spirometry for diagnosis and gradation of severity of airways obstruction. Failure to use post bronchodilator readings has been shown to overestimate the prevalence of COPD by 25 per cent45. Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g. 400mcg salbutamol).

Prior to performing post-bronchodilator spirometry, patients do not need to stop any therapy, such as long acting bronchodilators or inhaled steroids.

Routine reversibility testing is not recommended. However, where doubt exists as to whether the diagnosis is asthma or COPD, reversibility testing may add additional information to post bronchodilator readings alone and peak flow charts are useful. It is acknowledged that COPD and asthma can co-exist and that many patients with asthma who smoke will eventually develop irreversible airways obstruction. Where asthma is present, these patients should be managed as asthma patients as well as COPD patients. This will be evidenced by a greater than 400mls response to a reversibility test and a post bronchodilator FEV1 of less than 80 per cent of predicted normal as well as an appropriate medical history.

Patients with reversible airways obstruction should be included on the asthma register. Patients with coexisting asthma and COPD should be included on the register for both conditions.

Further information
NICE clinical guideline 101 (2010). Chronic obstructive pulmonary disease.
http://guidance.nice.org.uk/CG101/NICEGuidance/pdf/English

From April 2011 the diagnostic codes for this indicator have been updated to include new codes for post bronchodilator spirometry. The previous codes for reversibility testing will no longer be acceptable for QOF purposes.

COPD 15.2 Reporting and verification

The practice reports the percentage of patients diagnosed after 1 April 2011 who are on their COPD register, who have a record that the diagnosis has been confirmed by post bronchodilator spirometry.

For the purposes of the QOF, post bronchodilator spirometry undertaken between three months before and 12 months after a diagnosis of COPD being made would be considered as meeting the requirements of this indicator.

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 a record of post bronchodilator spirometry

3. inspection of a sample of records of patients for whom a record of post bronchodilator spirometry is claimed, to see if there is evidence of this in the medical records.

Prepared By Jean Keenan