QOF QOF 2008/2009

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Age must be 17 or over

Diagnostic codes for diabetes mellitus

C10E. Type 1 diabetes mellitus
C10E0 Type 1 diabetes mellitus with renal complications
C10E1 Type 1 diabetes mellitus with ophthalmic complications
C10E2 Type 1 diabetes mellitus with neurological complications
C10E3 Type 1 diabetes mellitus with multiple complications
C10E4 Unstable type 1 diabetes mellitus
C10E5 Type 1 diabetes mellitus with ulcer
C10E6 Type 1 diabetes mellitus with gangrene
C10E7 Type 1 diabetes mellitus with retinopathy
C10E8 Type 1 diabetes mellitus - poor control
C10E9 Type 1 diabetes mellitus maturity onset
C10EA Type 1 diabetes mellitus without complication
C10EB Type 1 diabetes mellitus with mononeuropathy
C10EC Type 1 diabetes mellitus with polyneuropathy
C10ED Type 1 diabetes mellitus with nephropathy
C10EE Type 1 diabetes mellitus with hypoglycaemic coma
C10EF Type 1 diabetes mellitus with diabetic cataract
C10EG Type 1 diabetes mellitus with peripheral angiopathy
C10EH Type 1 diabetes mellitus with arthropathy
C10EJ Type 1 diabetes mellitus with neuropathic arthropathy
C10EK Type 1 diabetes mellitus with persistent proteinuria
C10EL Type 1 diabetes mellitus with persistent microalbuminuria
C10EM Type 1 diabetes mellitus with ketoacidosis
C10EN Type 1 diabetes mellitus with ketoacidotic coma
C10EP Type 1 diabetes mellitus with exudative maculopathy
C10EQ Type 1 diabetes mellitus with gastroparesis
C10F. Type 2 diabetes mellitus
C10F0 Type 2 diabetes mellitus with renal complications
C10F1 Type 2 diabetes mellitus with ophthalmic complications
C10F2 Type 2 diabetes mellitus with neurological complications
C10F3 Type 2 diabetes mellitus with multiple complications
C10F4 Type 2 diabetes mellitus with ulcer
C10F5 Type 2 diabetes mellitus with gangrene
C10F6 Type 2 diabetes mellitus with retinopathy
C10F7 Type 2 diabetes mellitus - poor control
C10F9 Type 2 diabetes mellitus without complication
C10FA Type 2 diabetes mellitus with mononeuropathy
C10FB Type 2 diabetes mellitus with polyneuropathy
C10FC Type 2 diabetes mellitus with nephropathy
C10FD Type 2 diabetes mellitus with hypoglycaemic coma
C10FE Type 2 diabetes mellitus with diabetic cataract
C10FF Type 2 diabetes mellitus with peripheral angiopathy
C10FG Type 2 diabetes mellitus with arthropathy
C10FH Type 2 diabetes mellitus with neuropathic arthropathy
C10FJ Insulin treated Type 2 diabetes mellitus
C10FK Hyperosmolar non-ketotic state in type 2 diabetes mellitus
C10FL Type 2 diabetes mellitus with persistent proteinuria
C10FM Type 2 diabetes mellitus with persistent microalbuminuria
C10FN Type 2 diabetes mellitus with ketoacidosis
C10FP Type 2 diabetes mellitus with ketoacidotic coma
C10FQ Type 2 diabetes mellitus with exudative maculopathy
C10FR Type 2 diabetes mellitus with gastroparesis

Without a code for diabetes resolved

21263 Diabetes resolved
212H. Diabetes resolved

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DM 19.1 Rationale

It is not possible to undertake planned systematic care for patients with diabetes without a register which forms the basis of a recall system, and is needed in order to audit care.

The QOF does not specify how the diagnosis should be made, and a record of the diagnosis will, for the purposes of the QOF, be regarded as sufficient evidence of diabetes. However, in addition to the substantial number of undiagnosed patients with diabetes who exist, other patients are treated for diabetes when they do not in fact have the disease. Practices are therefore encouraged to adopt a systematic approach to the diagnosis of diabetes.

The World Health Organisation (WHO) 1999 criteria for the diagnosis of patients with diabetes mellitus are:

random glucose test: a glucose level above 11.1 mmol/l taken at a random time on two occasions is a diagnosis of diabetes
fasting glucose test: a glucose level above 7.0 mmol/l measured without anything to eat and on two different days is also a diagnosis of diabetes
glucose tolerance test: a blood glucose test is taken two hours after a glucose drink is given to the patient. A level above 11.1 mmol/l is a diagnosis of diabetes, while a level below 7.8 is normal. However, if the level falls between these values the patient may have a decreased tolerance for glucose (known as impaired glucose tolerance or IGT).

Distinguishing Type 1 and Type 2 diabetes clinically may not always be easy in primary care. If this is unclear from the patients’ paper or electronic records, the code for Type 1 diabetes should be used if the person is diagnosed with diabetes before the age of 30 or requires insulin within one year of diagnosis, and otherwise, the code for Type 2 should be used.

Separate coding of Type 1 and Type 2 diabetes allows the development of QOF indicators that are more closely aligned to NICE guidance.

As the care of children with diabetes mellitus is generally under the control of specialists, the register should exclude those patients age 16 and under. Likewise, the indicators are not intended to apply to patients with gestational diabetes.

DM 19.2 Reporting and verification

Practices should separately report the numbers of patients on their diabetic register (age 17 and over) with Type 1 and Type 2 diabetes and the number of patients on their diabetic register (age 17 and over) with Type 1 and Type 2 diabetes as a proportion of their total list size.

Practices should note that there has been a change to the acceptable read codes for this indicator to reflect the need for all patients to be recorded as having either Type 1 or Type 2 diabetes.

Verification – in order to ensure that patients with diabetes are not ‘lost’ due to the change in read codes, PCOs may wish to compare reported practice prevalence not only with national prevalence but with the practice prevalence for 2004/05.

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Prepared By Jean Keenan