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Contract specification changes v9 to v10

Contract Specification changes v18 to v20
• V19 Minor changes to indicator wording only, not affecting meaning of • V20 codes H333. (Acute exacerbation of asthma) and H33z1 (Asthma attack) • V20 Drug list tidied to exclude discontinued drugs • V20 added code 745D4 (Post bronchodilator spirometry) to spirometry codes • V20 added code 33950 (Diurnal variation of peak expiratory flow rate) to Atrial Fibrillation

• V20 Minor changes to indicator wording only, not affecting meaning of indicator

• Minor changes to indicator wording only, not affecting meaning of indicator
• V20 New read code within current diagnosis code groups - B627E Diffuse
• CHD 2 Removed (The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who are referred for exercise testing and/or specialist assessment). replaced by CHD13 • New Indicator CHD 13: For patients with newly diagnosed angina (diagnosed after 1 April 2011), the percentage who are referred for specialist assessment. Codeset refined to only cardiology referral codes. Care needed as codes for exercise tolerance testing are no longer accepted • Referral requires coding for patients with new angina after 1.4.11 and within 3 months before to 12 months after the angina diagnosis date • No exception coding for CHD13 (codes used for CHD2 removed) • V20 new code added to MI codes - Gyu36 [X]Subsequent myocardial • V20 added combination drug Hydrochlorothiazide + Olmesartan to A11 drug • CHD5 Removed (The percentage of patients with Coronary Heart Disease, whose notes
have a record of blood pressure in the previous 15 months). • CHD6 payment range now 40 – 71% (previously 40-70%) • CHD7 Removed (The percentage of patients with coronary heart disease, whose notes have a record of total cholesterol in the previous 15 months). • CHD11 Removed (The percentage of patients with a history of myocardial infarction (diagnosed after 1.4.03) who are currently treated with an ACE Inhibitor or angiotensin II antagonist). replaced by CHD14 • New Indicator CHD 14: The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin (unless a contraindication or side effects are recorded). Statin prescriptions and a code for over the counter statin are now included in the dataset. • Nec codeset created for Statin prescribing specifically for CHD14. Exception codes also added, the same as for Cholesterol measurements. • V20 - prescriptions for celvapan and pandemrix removed from the prescription • Minor changes to indicator wordings only, not affecting meaning of indicators • V20 added combination drug Hydrochlorothiazide + Olmesartan to A11 drug • COPD1 renumbered to COPD14 as changes to recommended diagnostic • COPD 15 (previously COPD12) date change so that post dilator spirometry now required for new diagnoses after 1.4.2011. • V19 significant changes to codesets. 33H%, 33I%, 33J%, 66Ta - 66Yb all removed. V19 Now only 2 codes acceptable 8HRC. (Referral for spirometry) and the newly added code 745D4 (Post bronchodilator spirometry). Care needed to use correct codes • V19 Spirometry exception codes - removed codes 8I2M. (Spirometry reversibility testing contraindicated) and 8I6d. (Spirometry reversibility testing not indicated) • Minor changes to wording and numbering of some indicators. Not affecting • V20 New codes added to the COPD review codes - 66YB0 (Chronic obstructive pulmonary disease 3 monthly review) and 66YB1 (Chronic obstructive pulmonary disease 6 monthly review) • V20 New code added to FEV1 codes - 339O1 (Forced expired volume in one • V20 - prescriptions for celvapan and pandemrix removed from the prescription
CVD – Primary Prevention

• Changes to wording of indicators, adding in age ranges for PP1 so only patients age 30 – 74 require CHD Risk assessment. Assessment required within 3 months of diagnosis. Dementia
• V19 New indicator - The percentage of patients with a new diagnosis of dementia (from 1 April 2011) with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded 6 months before or after entering on to the register. • V19 - Specified codes for the blood test results – additions to these codesets
Depression

• Minor changes to wording and numbering of some indicators. Not affecting • Timing for second assessment changed fron 5-12 weeks to 4-12 weeks. Indicator renamed to Dep5 (previously Dep3). • Changes to points available for Depression indicators. • Payment target range changes to 40-80% for Dep5.
Diabetes
• Targets for HbA1c changed to <=7.5, <=8, <=9 (or equivalent IFCC figures). New indicators, DM26, DM27 and DM28 for HbQ1c measurements. Indicator DM5, for HbA1c test removed to leave only those for target results. • Indicator for peripheral pulses, DM9, replaced with DM29, a record of foot • Codes for amputaions of legs can be used to exception codes fromDM29 and DM10, foot examination and neuropathy testing (need separate codes for both legs). • Adjustments made to exception codes for neuropathy testing and foot examination/risk assessment. Care needed to use correct codes. • DM11 removed – testing of blood presuure, leaving only BP target indicators. • BP indicators changes to two separate indicators for target of <= 150/90 • Indicator for cholesterol testing (DM16) removed leaving only for target of • V20 - prescriptions for celvapan and pandemrix removed from the prescription
Epilepsy

• Minor changes to wording and numbering of some indicators. Not affecting • Epilepsy 7 removed ( medication review) • V19 New indicator - The percentage of women under the age of 55 years who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception and pregnancy in the preceding 15 months. Exception codes available but care needed with coding requirements for this indicator.
Heart Failure

• Minor changes to wording of some indicators. Not affecting meaning of
Hypertension

• Minor changes to wording of some indicators. Not affecting meaning of
Hypothyroid

• Minor changes to wording of some indicators. Not affecting meaning of
Learning Disabilities

• Minor changes to wording of some indicators. Not affecting meaning of • V19 New indicator LD 2: The percentage of patients on the learning disability register with Down’s Syndrome aged 18 years and over who have a record of blood TSH in the preceding 15 months (excluding those who are on the thyroid disease register) Mental Health
• Addition of codes for MH in remission. These will permanently remove the patient from the MH register unless a subsequent MH code is added to their record. • Removal of MH9 which required coding of a Mental Health Review this has been replaced by several more specific indicators :- - MH11: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of alcohol consumption in the preceding 15 months - MH12: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of BMI in the preceding 15 months - MH13: The percentage of patients with schizophrenia, bipolar
affective disorder and other psychoses who have a record of blood pressure in the preceding 15 months. - MH14. The percentage of patients aged 40 years and over with
schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 15 months - MH15: The percentage of patients aged 40 years and over with
schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose in the preceding 15 months. - MH16: The percentage of patients (aged from 25 to 64 in England
and Northern Ireland, from 20 to 60 in Scotland and from 20 to 64 in Wales) with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years. • For patients on Lithium, Creatinine and TFT now required within previous 9 • Lithium levels in therapeutic range require entry within previous 4 months • New information in Contract guidance as to what should be considered for a • Removal of MH7 which required follow up within 2 weeks of patients who • Minor changes to wording of indicator. Not affecting meaning of indicators Palliative Care

• Minor changes to wording of indicator. Not affecting meaning of indicators • Minor changes to wording of indicators. Not affecting meaning of indicators
Sexual Health

- V20 new codes added for Contraception population (SH1) 61511 Insertion of T shaped 375 millimetres squared copper coated - V20 new codes added for LARC advice given (SH2 and SH3) 679K2 Education for intrauterine system 8CAw1 Verbal advice about long acting reversible contraception 8CAw2 Written advice about long acting reversible contraception Guidance stresses that both verbal and written information is required. If code 679K2 or 8CAw. (Advice about long acting reversible contraception) are used then it is assumed both have been given. If codes 8CAw1 or 8CAw2 are used the BOTH need to be entered to meet this indicator. • Minor changes to wording of indicators. Not affecting meaning of indicators Stroke / TIA
• V20 excluded code G669. (Cerebral palsy, not congenital or infantile, acute) • V20 added codes to the set for non-haemorrhagic stroke codes :- G665. Pure motor lacunar syndrome G666. Pure sensory lacunar syndrome Gyu63 [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs Gyu64 [X]Other cerebral infarction Gyu65 [X]Occlusion and stenosis of other precerebral arteries Gyu66 [X]Occlusion and stenosis of other cerebral arteries Gyu6G [X]Cereb infarct due unsp occlus/stenos precerebr arteries • Stroke5 removed (requirement to measure Blood pressure)

Source: http://www.scimp.scot.nhs.uk/wp-content/uploads/documents/ContractSpecificationchangesv18tov20.pdf

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