• Stroke codes - go to this
• TIA codes - go to this
• Declined Scan - go to this
• Exception codes - go to this
• Rationale - go to this

Diagnosed with Stroke or TIA after 1/4/2008

MRI / CT scan codes ( 3 months before diagnosis or up to 1 month after)

567.. Computerised axial tomography

5671. CAT scan requested

5672. CAT scan normal

5673. CAT scan abnormal

569.. Nuclear magnetic resonance

5691. Nuclear magn.reson.requested

5692. Nuclear magn reson normal

5693. Nuclear magn.reson. abnormal

5675. CAT scan - brain

567C. CAT scan brain - abnormal

5694. Magnetic resonance imaging of brain abnormal

569F. Magnetic resonance imaging of brain normal

5C00. CT scan brain - normal

8HQ3. Refer for NMR scanning

8HQ4. Refer for CAT scanning

8HBJ. Stroke / transient ischaemic attack referral

8HTQ. Referral to stroke clinic

Codes for MRI / CT declined (within 12 months of diagnosis date)

5695. Magnetic resonance imaging scan declined

56F0. CT scan brain declined

Stroke exception reporting codes (within last 15 months)

9h2.. Exception reporting: stroke quality indicators

9h21. Excepted from stroke quality indicators: Patient unsuitable

9h22. Excepted from stroke quality indicators: Informed dissent

Stroke codes

G61.. Intracerebral haemorrhage

G610. Cortical haemorrhage

G611. Internal capsule haemorrhage

G612. Basal nucleus haemorrhage

G613. Cerebellar haemorrhage

G614. Pontine haemorrhage

G615. Bulbar haemorrhage

G616. External capsule haemorrhage

G618. Intracerebral haemorrhage, multiple localized

G61X. Intracerebral haemorrhage in hemisphere, unspecified

G61X0 Left sided intracerebral haemorrhage, unspecified

G61X1 Right sided intracerebral haemorrhage, unspecified

G61z. Intracerebral haemorrhage NOS

G63y0 Cerebral infarct due to thrombosis of precerebral arteries

G63y1 Cerebral infarction due to embolism of precerebral arteries

 

G64.. Cerebral arterial occlusion

G640. Cerebral thrombosis

G6400 Cerebral infarction due to thrombosis of cerebral arteries

G641. Cerebral embolism

G6410 Cerebral infarction due to embolism of cerebral arteries

G64z. Cerebral infarction NOS

G64z0 Brainstem infarction

G64z1 Wallenberg syndrome

G64z2 Left sided cerebral infarction

G64z3 Right sided cerebral infarction

G64z4 Infarction of basal ganglia

G66.. Stroke and cerebrovascular accident unspecified

G660. Middle cerebral artery syndrome

G661. Anterior cerebral artery syndrome

G662. Posterior cerebral artery syndrome

G663. Brain stem stroke syndrome

G664. Cerebellar stroke syndrome

G665. Pure motor lacunar syndrome

G666. Pure sensory lacunar syndrome

G667. Left sided CVA

G668. Right sided CVA

G669. 00 Cerebral palsy, not congenital or infantile, acute

G6760 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

G6W.. Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries

G6X.. Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries
Gyu62 [X]Other intracerebral haemorrhage (v9)
Gyu63 [X]Cerebrl infarctn due/unspci occlusn or sten/cerebrl artrs (v9)
Gyu64 [X]Other cerebral infarction (v9)
Gyu65 [X]Occlusion and stenosis of other precerebral arteries (v9)
Gyu66 [X]Occlusion and stenosis of other cerebral arteries (v9)
Gyu6F [X]Intracerebral haemorrhage in hemisphere, unspecified (v9)
Gyu6G [X]Cereb infarct due unsp occlus/stenos precerebr arteries (v9)

 

TIA Codes

G65.. Transient cerebral ischaemia

G650. Basilar artery syndrome

G651. Vertebral artery syndrome

G6510 Vertebro-basilar artery syndrome

G652. Subclavian steal syndrome

G653. Carotid artery syndrome hemispheric

G654. Multiple and bilateral precerebral artery syndromes

G656. Vertebrobasilar insufficiency

G65y. Other transient cerebral ischaemia

G65z. Transient cerebral ischaemia NOS

G65z0 Impending cerebral ischaemia

G65z1 Intermittent cerebral ischaemia

G65zz Transient cerebral ischaemia NOS

F4236 Amaurosis fugax

Stroke 13.1 Rationale

The original indicator, stroke 2 suggested that patients needed to be referred for confirmation of the diagnosis by CT or MRI scan. However specialist investigations are often only accessible by a referral to secondary care services and therefore this indicator has been changed to reflect referral activity rather than confirmation by specific scanning investigations.

The NAO Report (Reducing brain damage: faster access to better stroke care. London; The Stationary Office 2005) highlights that UK national guidelines recommend that all patients with suspected TIA should be assessed and investigated within seven days, but notes that only a third of people with TIA are seen in a clinic. The UK Guideline and the NAO concern reflect the evidence that there is a high early risk of stroke following TIA, and that there is insufficient recognition of the serious nature of this diagnosis.

This indicator refers to patients diagnosed with a stroke or a TIA from 1 April 2008.

For the purposes of the QOF, an appropriate referral being undertaken between three months before and one month after a diagnosis of presumptive stroke or TIA being made would be considered as having met the requirements of this indicator.

A new TIA in someone who has had previous TIAs should be treated as an urgent case. However, if the patient is already on optimal therapy and has had their carotid arteries assessed, there is no need for further referral.

Stroke 13.2 Reporting and verification

The practice should report those patients who have been referred for further investigation within one month of being added to the register in whom a new diagnosis of stroke or TIA has been made since 1 April 2008. The practice should also report those who have been referred up to three months before being added to the register.

In verifying that this information has been correctly recorded, a number of approaches could be taken by a PCO:

i. Inspection of the output from a computer search that has been used to provide information on this indicator.
ii. Inspection of a sample of records of patients with stroke or TIA diagnosed after 1 April 2008 to look at the proportion referred for further investigation.
iii. Inspection of a sample of records of patients for whom a record of investigations such as CT or MRI scan is claimed, to see if there is evidence of this in the medical records.

Prepared By Jean Keenan