Newsletter volume 2 - 29 August 2008.doc.doc

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Newsletter volume 2 - 29 August 2008.doc.doc

  1. 1. NHS London London World Class Commissioning Assurance Newsletter Volume 2, August 2008
  2. 2. *Handbook clarification” NB: 300 words per competency total and not 300 words per indicator as implied by the hand book. Progress so far • Most sector groups are up and running and NHS London has or is about to attend all meetings with all of these. • We hope that all PCTs are now well underway with their CSPs. • An updated finance and activity template was updated onto NHS London’s website on 15th August. www.london.nhs.uk/wccassurance. • Do not forget that if you would like us to look at any sections of the plan in advance of the draft submission date of 26th September, please do not hesitate to send it through to strategy.planning@london.nhs.uk Communications Plan template This is now available on the website at: http://www.london.nhs.uk/publications/tools- and-resources/strategic-plans-and-world-class-commissioning-assurance-process WCC leads Please see the attached list for contacts in each PCT across London. Do work together in your sectors to establish best practise. CCI leads: NEL Monica McSharry monica.mcsharry@thpct.nhs.uk NWL Patricia Wright Patricia.Wright@hf-pct.nhs.uk NCL Liz Wise Liz.wise@camdenpct.nhs.uk SEL Tony Read Tony.read@greenwichpct.nhs.uk SWL Shirley Ann Carvill ShirleyAnne.Carvill@wpct.nhs.uk Healthcare Market Analysis A letter was sent on 22nd August by email to all PCT CEOs regarding work on the market management. This is available on NHS London’s website and we would urge representatives from each PCT to attend at least one of these sessions detailed below. FAQs An updated list of questions with answers can now be found on our website. www.london.nhs.uk/wccassurance. Please continue to use the strategy planning email address for further queries. Upcoming workshops Market Management 15 September – Understanding how markets within health are defined 26th September – CSP Market management and procurement strategies 2nd October – Making the theoretical applicable – applying market analysis to London London World Class Commissioning Assurance Newsletter, volume 2, 29 August 2008
  3. 3. 15th October – Translating the potential within markets to actual improvement Venue and available spaces to be confirmed. Organisational Development Organisation Development Workshop will take place at the beginning of October. Date to be confirmed. Working sessions We have run a number of individual working sessions with PCTs and combinations of PCTs within sectors. To date topics have included a more in-depth session on the finance and activity template, and fitting the local strategic plan with Healthcare for London priorities. Strategy.planning@london.nhs.uk We can still run sessions on aspects of the assurance process that you have a concern about. Please let us know as soon as possible if this is something you would like to arrange. Best Practice Hillingdon PCT have shared their work on data definitions for condition specific activity from Secondary Uses Submissions data for Stroke, COPD, Asthma, Diabetes, MSK and Pain Management , CHD, Heart Failure, End of Life care, General Surgery minor procedures and Gynaecology minor procedures. This can be found at the end of this document. If anyone else has anything they would like to share across London PCTs, please do let us have it so we can circulate this. Struggling to define outcomes? HSJ will be running a conference on Outcome measurement- Practical steps to defining and measuring health outcomes within a transforming NHS on 24th September. www.hsj-outcomemeasurement.co.uk Panel Days Dates have now been arranged and each PCT will have received a confirmation letter of this. Please refer to the panel guidance on the DH WCC site for more information about the format of this day. Interim Milestones Draft Submission date: 26th September Please let us know as soon as possible if you intend to submit a draft and whether this will include the finance template. Useful links All London specific templates and guidance, along with FAQs, presentations and other relevant documents can be found on our website at this link: http://london.nhs.uk/publications/tools-and-resources/strategic-plans-and-world- class-commissioning-assurance-process National information can be found on the Department of Health’s website: http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscomm issioning/Assurance/index.htm
  4. 4. Any questions about the process should be sent to the strategy planning team at: strategy.planning@london.nhs.uk Hillingdon PCT - Definitions 1.0 Introduction
  5. 5. The World Class Commissiong activity and finance template that needs be completed by November 21st 2008 contains several condition specific lines such as stroke and COPD for inpatient, outpatient and community activity. The current situation is that condition specific definitions can only be applied to inpatient activity as this is the only data set that records the diagnosis of the patient at time of treatment. No diagnosis is recorded on outpatient and community activity. This document details the options to Hillingdon PCT of how to select condition specific activity from Secondary Uses Submissions data for Stroke, COPD, Asthma, Diabetes,MSK and Pain Management , CHD, Heart Failure, End of Life care, General Surgery minor procedures and Gynaecology minor procedures; 2.0 Data Definitions 2.1 Stroke The definition of Stroke as detailed in the London Specific Finance and Activity Guidance maps is shown below; HRG HRG Description HRG HRG Fully partially maps maps A01 Intracranial Procedures Except Trauma - Category 1 √ A02 Intracranial Procedures Except Trauma - Category 2 √ A03 Intracranial Procedures Except Trauma - Category 3 √ A04 Intracranial Procedures Except Trauma - Category 4 √ A19 Haemorrhagic Cerebrovascular Disorders √ A20 Transient Ischaemic Attack >69 or w cc √ A21 Transient Ischaemic Attack <70 w/o cc √ A22 Non-Transient Stroke or Cerebrovascular Accident >69 or w cc √ A23 Non-Transient Stroke or Cerebrovascular Accident <70 w/o cc √ A99 Complex Elderly with a Nervous System Primary Diagnosis √ Q05 Extracranial or Upper Limb Arterial Surgery √ Note HRGs that fully map can be allocated to stroke in the templates. Further analysis of the HRGs that partially map will be required by PCTs to determine what proportion of HRG spells relate to stroke. Further detailed work is being undertaken by Healthcare for London in this area. This may result in a more detailed list of HRGs that partially map There are alternatives to using this method which better define stroke and have been used to calculate mortality rates from stroke on a national level over a number of years and are currently being used by NHS London to performance manage PCTs against a Vital Signs target. The definition for stroke taken from the Vital signs monitoring return guidance for target VSA 14 Patients who spend at least 90% of their time on a stroke unit issued for Q1 2008-09 by the Department of Health is any episode with an International Classification of Diseases ten (‘ICD-10’) diagnosis of; I630 Cerebral infarct due to thrombosis of precerebral arteries I631 Cerebral infarction due to embolism of precerebral arteries I632 Cereb infarct due unsp occlusion or stenos precerebrl arts I633 Cerebral infarction due to thrombosis of cerebral arteries
  6. 6. I634 Cerebral infarction due to embolism of cerebral arteries I635 Cerebrl infarct due unspec occlusion or stenos cerebrl arts I636 Cereb infarct due cerebral venous thrombosis, nonpyogenic I638 Other cerebral infarction I639 Cerebral infarction, unspecified I64X Stroke, not specified as haemorrhage or infarction I650 Occlusion and stenosis of vertebral artery I651 Occlusion and stenosis of basilar artery I652 Occlusion and stenosis of carotid artery I653 Occlusion and stenosis of multip and bilat precerebrl arts I658 Occlusion and stenosis of other precerebral artery I659 Occlusion and stenosis of unspecified precerebral artery I660 Occlusion and stenosis of middle cerebral artery I661 Occlusion and stenosis of anterior cerebral artery I662 Occlusion and stenosis of posterior cerebral artery I663 Occlusion and stenosis of cerebellar arteries I664 Occlusion and stenosis of multiple and bilat cerebrl arts I668 Occlusion and stenosis of other cerebral artery I669 Occlusion and stenosis of unspecified cerebral artery I672 Cerebral atherosclerosis I674 Hypertensive encephalopathy I675 Moyamoya disease I676 Nonpyogenic thrombosis of intracranial venous system I677 Cerebral arteritis, not elsewhere classified I678 Other specified cerebrovascular diseases I679 Cerebrovascular disease, unspecified The collection was on a PCT commissioner basis and although not stated it is presumed that only patients with a primary diagnosis of the above codes would be reported on. There are other definitions of Stroke that are available from published sources Health Care Needs Assessment 2nd Edition 2004 Volume 1 classifies stroke as ICD I60 to I69; I60 Subarachnoid haemorrhage I600 Subarachnoid haemorrhage from carotid siphon and bifurcation I601 Subarachnoid haemorrhage from middle cerebral artery I602 Subarachnoid haemorrhage from anterior communicating artery I603 Subarachnoid haemorrhage from posterior communicating artery I604 Subarachnoid haemorrhage from basilar artery I605 Subarachnoid haemorrhage from vertebral artery I606 Subarachnoid haemorrhage from other intracranial arteries I607 Subarachnoid haemorrhage from intracranial artery, unspec I608 Other subarachnoid haemorrhage I609 Subarachnoid haemorrhage, unspecified I61 Intracerebral haemorrhage I610 Intracerebral haemorrhage in hemisphere, subcortical I611 Intracerebral haemorrhage in hemisphere, cortical I612 Intracerebral haemorrhage in hemisphere, unspecified I613 Intracerebral haemorrhage in brain stem I614 Intracerebral haemorrhage in cerebellum I615 Intracerebral haemorrhage, intraventricular I616 Intracerebral haemorrhage, multiple localized I618 Other intracerebral haemorrhage I619 Intracerebral haemorrhage, unspecified I62 Other nontraumatic intracranial haemorrhage I620 Subdural haemorrhage (acute)(nontraumatic)
  7. 7. I621 Nontraumatic extradural haemorrhage I629 Intracranial haemorrhage (nontraumatic), unspecified I63 Cerebral infarction I630 Cerebral infarct due to thrombosis of precerebral arteries I631 Cerebral infarction due to embolism of precerebral arteries I632 Cereb infarct due unsp occlusion or stenos precerebrl arts I633 Cerebral infarction due to thrombosis of cerebral arteries I634 Cerebral infarction due to embolism of cerebral arteries I635 Cerebrl infarct due unspec occlusion or stenos cerebrl arts I636 Cereb infarct due cerebral venous thrombosis, nonpyogenic I638 Other cerebral infarction I639 Cerebral infarction, unspecified I64X Stroke, not specified as haemorrhage or infarction I65 Occlusion/stenos precerebral arts not result cerebrl infarct I650 Occlusion and stenosis of vertebral artery I651 Occlusion and stenosis of basilar artery I652 Occlusion and stenosis of carotid artery I653 Occlusion and stenosis of multip and bilat precerebrl arts I658 Occlusion and stenosis of other precerebral artery I659 Occlusion and stenosis of unspecified precerebral artery I66 Occlusion/stenosis cerebral arts not result cerebral infarct I660 Occlusion and stenosis of middle cerebral artery I661 Occlusion and stenosis of anterior cerebral artery I662 Occlusion and stenosis of posterior cerebral artery I663 Occlusion and stenosis of cerebellar arteries I664 Occlusion and stenosis of multiple and bilat cerebrl arts I668 Occlusion and stenosis of other cerebral artery I669 Occlusion and stenosis of unspecified cerebral artery I67 Other cerebrovascular diseases I670 Dissection of cerebral arteries, nonruptured I671 Cerebral aneurysm, nonruptured I672 Cerebral atherosclerosis I673 Progressive vascular leukoencephalopathy I674 Hypertensive encephalopathy I675 Moyamoya disease I676 Nonpyogenic thrombosis of intracranial venous system I677 Cerebral arteritis, not elsewhere classified I678 Other specified cerebrovascular diseases I679 Cerebrovascular disease, unspecified I68 Cerebrovascular disorders in diseases classified elsewhere I680 A Cerebral amyloid angiopathy I681 A Cerebral arteritis in infect & parasit dis classif elsewh I682 A Cerebral arteritis in other diseases classified elsewhere I688 A Other cerebrovascular disorders in diseases EC I69 Sequelae of cerebrovascular disease I690 Sequelae of subarachnoid haemorrhage I691 Sequelae of intracerebral haemorrhage I692 Sequelae of other nontraumatic intracranial haemorrhage I693 Sequelae of cerebral infarction I694 Sequelae of stroke, not spec as haemorrhage or infarction I698 Sequelae of other and unspecified cerebrovascular diseases This definition is consistent with the National Centre for Health Outcomes Development used to calculate mortality from stroke and has been in use for a number of years. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Recommendation
  8. 8. To use ICD10 codes I60 to I69 as listed above to classify stroke and that only the primary diagnosis field is used and the basis is a responsible commissioner basis within the specialty Neurology. Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of Stroke patients and apportion to Neurology. A discussion needs to be held at SHA Level to decide whether we capture stroke admissions for other specialties apart from Neurology , (see public health comment below). Public Health View Compendium uses I60-69 for stroke mortality and I61-I64 for emergency hosp admisssions for stroke. Cardiac network Public Health lead advice is to use I60-I69 as you suggest. The major problem is by using just the neurology specialty which will miss lots of spells which could be recorded under General Medicine or Care of the Elderly for example. 2.2 Chronic Obstructive Pulmonary Disease (‘COPD’) The definition of COPD from Health Care Needs Assessment 2nd Edition 2004 Volume 1 classifies COPD as ICD 10 code J44 Chronic Obstructive Pulmonary Disease. The NICE and Brit Thoracic society use J40-44 when estimating mortality from COPD. Version 3.5 of Healthcare Resource Group Codes matched two codes to COPD; D39 Chronic Obstructive Pulmonary Disease or Bronchitis w cc D40 Chronic Obstructive Pulmonary Disease or Bronchitis w/o cc Using these codes could also capture activity covered by Bronchitis including ICD 10 codes J41 Chronic Bronchitis type specified and J42 Chronic Bronchitis unspecified Recommendation To use ICD10 Code J40 to J44 to classify COPD as the HRG codes will cover patients who have been diagnosed with bronchitis. Only primary diagnosis field to be used and selection on a responsible commissioner basis within the specialty General Medicine as classified in the WCC template. A discussion needs to be held at SHA Level to decide whether we capture COPD admissions for other specialties apart from General medicine , (see public health comment below, this is the same issue as stroke). By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of COPD patients and apportion to General Medicine. Public Health Comment This is a difficult one this as various people use various ICD codes to identify COPD which relects the fact that it goes across a spectrum of conditions which often but not always have the prime definition of COPD: airway obstruction that is not fully reversible. These conditions include chronic bronchitis and emphysema. NICE and Brit Thoracic society use J40-44 when estimating mortality from COPD, so I suggest that is reasonable. It may pick up some chronic bronchitis that is not COPD but these, I guess, will be small numbers for hospital admissions as it is unlikely that simple bronchitis is the main cause of hospital admissions. COPD admissions could also be assigned to other specialties than just General Medicine. 2.3 Asthma The definition of Asthma from Health Care Needs Assessment 2nd Edition 2004 Volume 1 classifies Asthma as ICD 10 code J45 Asthma Specified or Unspecified and J46 Status Asthmaticus.
  9. 9. Version 3.5 of Healthcare Resource Group Codes matched two codes to Asthma; D21 Asthma w cc D22 Asthma w/o cc Recommendation To use ICD10 Code J45 and J46 to classify Asthma as this is consistent with using diagnosis codes to identify Asthma not HRG codes. Only primary diagnosis field to be used and selection on a responsible commissioner basis within General Medicine. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. A discussion needs to be held at SHA Level to decide whether we capture Asthma admissions for other specialties apart from General medicine , (see public health comment below, this is the same issue as stroke and COPD). Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of Asthma patients and apportion to General medicine . Public Health Comment Agreed the code suggested seems fine but specialties need to be broadened beyond General Medicine. 2.4 Diabetes The definition of Diabetes from Health Care Needs Assessment 2nd Edition 2004 Volume 1 classifies Diabetes Categories as ICD10 code E10 to E15; E10 Insulin-dependent diabetes mellitus E100 Insulin-dependent diabetes mellitus with coma E101 Insulin-dependent diabetes mellitus with ketoacidosis E102 Insulin-dependent diabetes mellitus with renal complications E102 D INSULIN DEPENDENT DIABETES MELLITUS WITH RENAL COMPLICATIONS E103 Insulin-dependent diabetes mellitus with ophthalmic comps E103 D INSULIN DEPENDENT DIABETES MELLITUS WITH OPTHALMIC COMPLICAT E104 Insulin-dependent diabetes mellitus with neurological comps E105 Insulin-dependent diabetes mellitus with periph circ comps E106 Insulin-dependent diabetes mellitus with other spec comps E107 Insulin-dependent diabetes mellitus with multiple comps E108 Insulin-dependent diabetes mellitus with unspec comps E109 Insulin-dependent diabetes mellitus without complications E11 Non-insulin-dependent diabetes mellitus E110 Non-insulin-dependent diabetes mellitus with coma E111 Non-insulin-dependent diabetes mellitus with ketoacidosis E112 Non-insulin-dependent diabetes mellitus with renal comps E113 Non-insulin-dependent diabetes mellitus with ophthalm comps E113 D NON-INSULIN DEPENDENT DIABETES MELLITUS WITH OPTHALMIC COMPS E114 Non-insulin-dependent diabetes mellitus with neuro comps E115 Non-insulin-depend diabetes mellitus with periph circ comp E116 Non-insulin-depend diabetes mellitus with other spec comp E117 Non-insulin-dependent diabetes mellitus with multiple comps E118 Non-insulin-dependent diabetes mellitus with unspec comps E119 Non-insulin-depend diabetes mellitus without complication E12 Malnutrition-related diabetes mellitus E120 Malnutrition-related diabetes mellitus with coma E121 Malnutrition-related diabetes mellitus with ketoacidosis E122 Malnutrition-related diabetes mellitus with renal comps
  10. 10. E123 Malnutrition-related diabetes mellitus with ophthalmic comps E124 Malnutrition-related diabetes mellitus with neuro comps E125 Malnutrition-relat diabetes mellitus with periph circ comp E126 Malnutrition-relat diabetes mellitus with other spec comps E127 Malnutrition-related diabetes mellitus with multiple comps E128 Malnutrition-related diabetes mellitus with unspec comps E129 Malnutrition-related diabetes mellitus without complications E13 Other specified diabetes mellitus E130 Other specified diabetes mellitus with coma E131 Other specified diabetes mellitus with ketoacidosis E132 Other specified diabetes mellitus with renal complications E133 Other specified diabetes mellitus with ophthalmic comps E134 Other specified diabetes mellitus with neurological comps E135 Other specified diabetes mellitus with periph circ comps E136 Other specified diabetes mellitus with other spec comps E137 Other specified diabetes mellitus with multiple comps E138 Other specified diabetes mellitus with unspecified comps E139 Other specified diabetes mellitus without complications E14 Unspecified diabetes mellitus E140 Unspecified diabetes mellitus with coma E141 Unspecified diabetes mellitus with ketoacidosis E142 Unspecified diabetes mellitus with renal complications E143 Unspecified diabetes mellitus with ophthalmic complications E144 Unspecified diabetes mellitus with neurological comps E145 Unspecified diabetes mellitus with periph circulatory comps E146 Unspecified diabetes mellitus with other specified comps E147 Unspecified diabetes mellitus with multiple complications E148 Unspecified diabetes mellitus with unspecified complications E149 Unspecified diabetes mellitus without complications E15X Nondiabetic hypoglycaemic coma Version 3.5 of Healthcare Resource Group Codes matches seven codes to Diabetes; K11 Diabetes with Hypoglycaemic Emergency >69 or w cc K12 Diabetes with Hypoglycaemic Emergency <70 w/o cc K13 Diabetes with Hyperglycaemic Emergency >69 or w cc K14 Diabetes with Hyperglycaemic Emergency <70 w/o cc K15 Diabetes and Other Hyperglycaemic Disorder >69 or w cc K16 Diabetes and Other Hyperglycaemic Disorder <70 w/o cc K17 Diabetes with Lower Limb Complications Recommendation To use ICD10 Code E10 to E14 to classify Diabetes as this is consistent with using diagnosis codes to identify COPD/Asthma not HRG codes. Only primary diagnosis field to be used and selection on a responsible commissioner basis. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Outpatient data could be mapped as Diabetic medicine has its own specialty code 307. The only potential problem is that some patients with a diabetes condition could be seen in an Endocrinology outpatient clinic. An option could be to calculate the % by specialty of diabetes inpatients in Endocrinology and apportion to outpatient activity. Public Health Comment Not sure why Health Care Needs Assessment 2nd Edition 2004 Volume 1choose to use E15 as this clearly says non diabetic coma. I’d use E10-E14 Only as this is what compendium uses for diabetes mortality.
  11. 11. 2.5 Rheumatology (MSK and Pain management) World Mapper website classifies deaths from Musculoskeletal disease as ICD 10 code M00 to M99; M00 Pyogenic arthritis M000 Staphylococcal arthritis and polyarthritis M001 Pneumococcal arthritis and polyarthritis M002 Other streptococcal arthritis and polyarthritis M008 Arthritis and polyarthritis due other spec bacterial agents M009 Pyogenic arthritis, unspecified M01 Direct infections joint in infectious and parasitic dis EC M010 A Meningococcal arthritis M011 A Tuberculous arthritis M012 A Arthritis in Lyme disease M013 A Arthritis in other bacterial diseases classified elsewhere M014 A Rubella arthritis M015 A Arthritis in other viral diseases classified elsewhere M016 A Arhritis in mycoses M018 A Arthritis in other infectious and parasitic diseases EC M02 Reactive arthropathies M020 Arthropathy following intestinal bypass M021 Postdysenteric arthropathy M022 Postimmunization arthropathy M023 Reiter's disease M028 Other reactive arthropathies M029 Reactive arthropathy, unspecified M03 Postinfective and reactive arthropathies in diseases EC M030 A Postmeningococcal arthritis M031 A Postinfective arthropathy in syphilis M032 A Other postinfectious arthropathies in diseases EC M036 A Reactive arthropathy in other diseases classified elsewhere M05 Seropositive rheumatoid arthritis M050 Felty's syndrome M051 D Rheumatoid lung disease M052 Rheumatoid vasculitis M053 D Rheumatoid arthritis with involvement of oth organs and sys M058 Other seropositive rheumatoid arthritis M059 Seropositive rheumatoid arthritis, unspecified M06 Other rheumatoid arthritis M060 Seronegative rheumatoid arthritis M061 Adult-onset Still's disease M062 Rheumatoid bursitis M063 Rheumatoid nodule M064 Inflammatory polyarthropathy M068 Other specified rheumatoid arthritis M069 Rheumatoid arthritis, unspecified M07 Psoriatic and enteropathic arthropathies M070 A Distal interphalangeal psoriatic arthropathy M071 A Arthritis mutilans M072 A Psoriatic spondylitis M073 A Other psoriatic arthropathies M074 A Arthropathy in Crohn's disease [regional enteritis] M075 A Arthropathy in ulcerative colitis M076 A Other enteropathic arthropathies M08 Juvenile arthritis
  12. 12. M080 Juvenile rheumatoid arthritis M081 Juvenile ankylosing spondylitis M082 Juvenile arthritis with systemic onset M083 Juvenile polyarthritis (seronegative) M084 Pauciarticular juvenile arthritis M088 Other juvenile arthritis M089 Juvenile arthritis, unspecified M09 Juvenile arthritis in diseases classified elsewhere M090 A Juvenile arthritis in psoriasis M091 A Juvenile arthritis in Crohn's disease [reg enteritis] M092 A Juvenile arthritis in ulcerative colitis M098 A Juvenile arthritis in other diseases classified elsewhere M10 Gout M100 Idiopathic gout M101 Lead-induced gout M102 Drug-induced gout M103 Gout due to impairment of renal function M104 Other secondary gout M109 Gout, unspecified M11 Other crystal arthropathies M110 Hydroxyapatite deposition disease M111 Familial chondrocalcinosis M112 Other chondrocalcinosis M118 Other specified crystal arthropathies M119 Crystal arthropathy, unspecified M12 Other specific arthropathies M120 Chronic postrheumatic arthropathy [Jaccoud] M121 Kaschin-Beck disease M122 Villonodular synovitis (pigmented) M123 Palindromic rheumatism M124 Intermittent hydrarthrosis M125 Traumatic arthropathy M128 Other specific arthropathies, not elsewhere classified M13 Other arthritis M130 Polyarthritis, unspecified M131 Monoarthritis, not elsewhere classified M138 Other specified arthritis M139 Arthritis, unspecified M14 Arthropathies in other diseases classified elsewhere M140 A Gouty arthropathy due enzym defect and oth inherit disorder M141 A Crystal arthropathy in other metabolic disorders M142 A Diabetic arthropathy M143 A Lipoid dermatoarthritis M144 A Arthropathy in amylodosis M145 A Arthropathies oth endocrine nutrition and metabol disorder M146 A Neuropathic arthropathy M148 A Arthropathies in other specified diseases EC M15 Polyarthrosis M150 Primary generalized (osteo)arthrosis M151 Heberden's nodes (with arthropathy) M152 Bouchard's nodes (with arthropathy) M153 Secondary multiple arthrosis M154 Erosive (osteo)arthrosis M158 Other polyarthrosis M159 Polyarthrosis, unspecified M16 Coxarthrosis [arthrosis of hip]
  13. 13. M160 Primary coxarthrosis, bilateral M161 Other primary coxarthrosis M162 Coxarthrosis resulting from dysplasia, bilateral M163 Other dysplastic coxarthrosis M164 Post-traumatic coxarthrosis, bilateral M165 Other post-traumatic coxarthrosis M166 Other secondary coxarthrosis, bilateral M167 Other secondary coxarthrosis M169 Coxarthrosis, unspecified M17 Gonarthrosis [arthrosis of knee] M170 Primary gonarthrosis, bilateral M171 Other primary gonarthrosis M172 Post-traumatic gonarthrosis, bilateral M173 Other post-traumatic gonarthrosis M174 Other secondary gonarthrosis, bilateral M175 Other secondary gonarthrosis M179 Gonarthrosis, unspecified M18 Arthrosis of first carpometacarpal joint M180 Primary arthrosis of first carpometacarpal joints, bilateral M181 Other primary arthrosis of first carpometacarpal joint M182 Post-traumatic arthrosis of first carpometacarpal jt bilat M183 Other post-traumatic arthrosis of first carpometacarpal jt M184 Oth sec arthrosis of first carpometacarpal joints bilateral M185 Other secondary arthrosis of first carpometacarpal joint M189 Arthrosis of first carpometacarpal joint, unspecified M19 Other arthrosis M190 Primary arthrosis of other joints M191 Post-traumatic arthrosis of other joints M192 Secondary arthrosis of other joints M198 Other specified arthrosis M199 Arthrosis, unspecified M20 Acquired deformities of fingers and toes M200 Deformity of finger(s) M201 Hallux valgus (acquired) M202 Hallux rigidus M203 Other deformity of hallux (acquired) M204 Other hammer toe(s) (acquired) M205 Other deformities of toe(s) (acquired) M206 Acquired deformity of toe(s), unspecified M21 Other acquired deformities of limbs M210 Valgus deformity, not elsewhere classified M211 Varus deformity, not elsewhere classified M212 Flexion deformity M213 Wrist or foot drop (acquired) M214 Flat foot [pes planus] (acquired) M215 Acquired clawhand, clubhand, clawfoot and clubfoot M216 Other acquired deformities of ankle and foot M217 Unequal limb length (acquired) M218 Other specified acquired deformities of limbs M219 Acquired deformity of limb, unspecified M22 Disorders of patella M220 Recurrent dislocation of patella M221 Recurrent subluxation of patella M222 Patellofemoral disorders M223 Other derangements of patella M224 Chondromalacia patellae
  14. 14. M228 Other disorders of patella M229 Disorder of patella, unspecified M23 Internal derangement of knee M230 Cystic meniscus M231 Discoid meniscus (congenital) M232 Derangement of meniscus due to old tear or injury M233 Other meniscus derangements M234 Loose body in knee M235 Chronic instability of knee M236 Other spontaneous disruption of ligament(s) of knee M238 Other internal derangements of knee M239 Internal derangement of knee, unspecified M24 Other specific joint derangements M240 Loose body in joint M241 Other articular cartilage disorders M242 Disorder of ligament M243 Pathological dislocation and subluxation of joint NEC M244 Recurrent dislocation and subluxation of joint M245 Contracture of joint M246 Ankylosis of joint M247 Protrusio acetabuli M248 Other specific joint derangements, not elsewhere classified M249 Joint derangement, unspecified M25 Other joint disorders, not elsewhere classified M250 Haemarthrosis M251 Fistula of joint M252 Flail joint M253 Other instability of joint M254 Effusion of joint M255 Pain in joint M256 Stiffness of joint, not elsewhere classified M257 Osteophyte M258 Other specified joint disorders M259 Joint disorder, unspecified M30 Polyarteritis nodosa and related conditions M300 Polyarteritis nodosa M301 Polyarteritis with lung involvement [Churg-Strauss] M302 Juvenile polyarteritis M303 Mucocutaneous lymph node syndrome [Kawasaki] M308 Other conditions related to polyarteritis nodosa M31 Other necrotizing vasculopathies M310 Hypersensitivity angiitis M311 Thrombotic microangiopathy M312 Lethal midline granuloma M313 Wegener's granulomatosis M314 Aortic arch syndrome [Takayasu] M315 Giant cell arteritis with polymyalgia rheumatica M316 Other giant cell arteritis M318 Other specified necrotizing vasculopathies M319 Necrotizing vasculopathy, unspecified M32 Systemic lupus erythematosus M320 Drug-induced systemic lupus erythematosus M321 D Systemic lupus erythematosus with organ or sys involv M328 Other forms of systemic lupus erythematosus M329 Systemic lupus erythematosus, unspecified M33 Dermatopolymyositis
  15. 15. M330 Juvenile dermatomyositis M331 Other dermatomyositis M332 Polymyositis M339 Dermatopolymyositis, unspecified M34 Systemic sclerosis M340 Progressive systemic sclerosis M341 CR(E)ST syndrome M342 Systemic sclerosis induced by drugs and chemicals M348 Other forms of systemic sclerosis M349 Systemic sclerosis, unspecified M35 Other systemic involvement of connective tissue M350 Sicca syndrome [Sjogren] M351 Other overlap syndromes M352 Behcet's disease M353 Polymyalgia rheumatica M354 Diffuse (eosinophilic) fasciitis M355 Multifocal fibrosclerosis M356 Relapsing panniculitis [Weber-Christian] M357 Hypermobility syndrome M358 Other specified systemic involvement of connective tissue M359 Systemic involvement of connective tissue, unspecified M36 Systemic disorders of connective tissue in diseases EC M360 A Dermato(poly)myositis in neopastic disease M361 A Arthropathy in neopastic disease M362 A Haemophilic arthropathy M363 A Arthropathy in other blood disorders M364 A Arthropathy in hypersensitivity reactions EC M368 A Systemic disord of connective tissue in other diseases EC M40 Kyphosis and lordosis M400 Postural kyphosis M401 Other secondary kyphosis M402 Other and unspecified kyphosis M403 Flatback syndrome M404 Other lordosis M405 Lordosis, unspecified M41 Scoliosis M410 Infantile idiopathic scoliosis M411 Juvenile idiopathic scoliosis M412 Other idiopathic scoliosis M413 Thoracogenic scoliosis M414 Neuromuscular scoliosis M415 Other secondary scoliosis M418 Other forms of scoliosis M419 Scoliosis, unspecified M42 Spinal osteochondrosis M420 Juvenile osteochondrosis of spine M421 Adult osteochondrosis of spine M429 Spinal osteochondrosis, unspecified M43 Other deforming dorsopathies M430 Spondylolysis M431 Spondylolisthesis M432 Other fusion of spine M433 Recurrent atlantoaxial subluxation with myelopathy M434 Other recurrent atlantoaxial subluxation M435 Other recurrent vertebral subluxation M436 Torticollis
  16. 16. M438 Other specified deforming dorsopathies M439 Deforming dorsopathy, unspecified M45X Ankylosing spondylitis M46 Other inflammatory spondylopathies M460 Spinal enthesopathy M461 Sacroiliitis, not elsewhere classified M462 Osteomyelitis of vertebra M463 Infection of intervertebral disc (pyogenic) M464 Discitis, unspecified M465 Other infective spondylopathies M468 Other specified inflammatory spondylopathies M469 Inflammatory spondylopathy, unspecified M47 Spondylosis M470 D Ant spinal and vertebral artery compression syndromes M471 Other spondylosis with myelopathy M472 Other spondylosis with radiculopathy M478 Other spondylosis M479 Spondylosis, unspecified M48 Other spondylopathies M480 Spinal stenosis M481 Ankylosing hyperostosis [Forestier] M482 Kissing spine M483 Traumatic spondylopathy M484 Fatigue fracture of vertebra M485 Collapsed vertebra, not elsewhere classified M488 Other specified spondylopathies M489 Spondylopathy, unspecified M49 Spondylopathies in diseases classified elsewhere M490 A Tuberculosis of spine M491 A Brucella spondylitis M492 A Enterobacterial spondylitis M493 A Spondylopathy in other infectious and parasitic dis EC M494 A Neuropathic spondylopathy M495 A Collapsed vertebra in diseases classified elsewhere M498 A Spondylopathy in other diseases classified elsewhere M50 Cervical disc disorders M500 D Cervical disc disorder with myelopathy M501 Cervical disc disorder with radiculopathy M501 D CERVICAL DISC DISORDER WITH RADICULOPATHY M502 Other cervical disc displacement M503 Other cervical disc degeneration M508 Other cervical disc disorders M509 Cervical disc disorder, unspecified M51 Other intervertebral disc disorders M510 D Lumbar and other intrvertbrl disc disord with mylopathy M511 Lumb and oth intrvertbrl disc disorders with radiculopathy M511 D LUMBAR AND OTHER INTERVERTABRAL DISC DISORDERS WITH RADICULO M512 Other specified intervertebral disc displacement M513 Other specified intervertebral disc degeneration M514 Schmorl's nodes M518 Other specified intervertebral disc disorders M519 Intervertebral disc disorder, unspecified M53 Other dorsopathies, not elsewhere classified M530 Cervicocranial syndrome M531 Cervicobrachial syndrome M532 Spinal instabilities
  17. 17. M533 Sacrococcygeal disorders, not elsewhere classified M538 Other specified dorsopathies M539 Dorsopathy, unspecified M54 Dorsalgia M540 Panniculitis affecting regions of neck and back M541 Radiculopathy M542 Cervicalgia M543 Sciatica M544 Lumbago with sciatica M545 Low back pain M546 Pain in thoracic spine M548 Other dorsalgia M549 Dorsalgia, unspecified M60 Myositis M600 Infective myositis M601 Interstitial myositis M602 Foreign body granuloma of soft tissue NEC M608 Other myositis M609 Myositis, unspecified M61 Calcification and ossification of muscle M610 Myositis ossificans traumatica M611 Myositis ossificans progressiva M612 Paralytic calcification and ossification of muscle M613 Calcification and ossification of muscles assoc with burns M614 Other calcification of muscle M615 Other ossification of muscle M619 Calcification and ossification of muscle, unspecified M62 Other disorders of muscle M620 Diastasis of muscle M621 Other rupture of muscle (nontraumatic) M622 Ischaemic infarction of muscle M623 Immobility syndrome (paraplegic) M624 Contracture of muscle M625 Muscle wasting and atrophy, not elsewhere classified M626 Muscle strain M628 Other specified disorders of muscle M629 Disorder of muscle, unspecified M63 Disorders of muscle in diseases classified elsewhere M630 A Myositis in bacterial diseases classified elsewhere M631 A Myositis in protozoal and parasitic infections EC M632 A Myositis in other infectious diseases classified elsewhere M633 A Myositis in sarcoidosis M638 A Other disorders of muscle in diseases classified elsewhere M65 Synovitis and tenosynovitis M650 Abscess of tendon sheath M651 Other infective (teno)synovitis M652 Calcific tendinitis M653 Trigger finger M654 Radial styloid tenosynovitis [de Quervain] M658 Other synovitis and tenosynovitis M659 Synovitis and tenosynovitis, unspecified M66 Spontaneous rupture of synovium and tendon M660 Rupture of popliteal cyst M661 Rupture of synovium M662 Spontaneous rupture of extensor tendons M663 Spontaneous rupture of flexor tendons
  18. 18. M664 Spontaneous rupture of other tendons M665 Spontaneous rupture of unspecified tendon M67 Other disorders of synovium and tendon M670 Short Achilles tendon (acquired) M671 Other contracture of tendon (sheath) M672 Synovial hypertrophy, not elsewhere classified M673 Transient synovitis M674 Ganglion M678 Other specified disorders of synovium and tendon M679 Disorder of synovium and tendon, unspecified M68 Disorder of synovium and tendon in dis classif elsewhere M680 A Synovitis and tenosynovitis in bacterial diseases EC M688 A Other disorders of synovium and tendon in diseases EC+ M70 Soft tissue disorders related to use, overuse and pressure M700 Chronic crepitant synovitis of hand and wrist M701 Bursitis of hand M702 Olecranon bursitis M703 Other bursitis of elbow M704 Prepatellar bursitis M705 Other bursitis of knee M706 Trochanteric bursitis M707 Other bursitis of hip M708 Oth soft tiss disorder related to use overuse and pressure M709 Unsp soft tis disorder related to use overuse and pressure M71 Other bursopathies M710 Abscess of bursa M711 Other infective bursitis M712 Synovial cyst of popliteal space [Baker] M713 Other bursal cyst M714 Calcium deposit in bursa M715 Other bursitis, not elsewhere classified M718 Other specified bursopathies M719 Bursopathy, unspecified M72 Fibroblastic disorders M720 Palmar fascial fibromatosis [Dupuytren] M721 Knuckle pads M722 Plantar fascial fibromatosis M723 Nodular fasciitis M724 Pseudosarcomatous fibromatosis M725 Fasciitis, not elsewhere classified M728 Other fibroblastic disorders M729 Fibroblastic disorder, unspecified M73 Soft tissue disorders in diseases classified elsewhere M730 A Gonococcal bursitis M731 A Syphilitic bursitis M738 A Other soft tissue disorders in diseases classified elsewhere M75 Shoulder lesions M750 Adhesive capsulitis of shoulder M751 Rotator cuff syndrome M752 Bicipital tendinitis M753 Calcific tendinitis of shoulder M754 Impingement syndrome of shoulder M755 Bursitis of shoulder M758 Other shoulder lesions M759 Shoulder lesion, unspecified M76 Enthesopathies of lower limb, excluding foot
  19. 19. M760 Gluteal tendinitis M761 Psoas tendinitis M762 Iliac crest spur M763 Iliotibial band syndrome M764 Tibial collateral bursitis [Pellegrini-Stieda] M765 Patellar tendinitis M766 Achilles tendinitis M767 Peroneal tendinitis M768 Other enthesopathies of lower limb, excluding foot M769 Enthesopathy of lower limb, unspecified M77 Other enthesopathies M770 Medial epicondylitis M771 Lateral epicondylitis M772 Periarthritis of wrist M773 Calcaneal spur M774 Metatarsalgia M775 Other enthesopathy of foot M778 Other enthesopathies, not elsewhere classified M779 Enthesopathy, unspecified M79 Other soft tissue disorders, not elsewhere classified M790 Rheumatism, unspecified M791 Myalgia M792 Neuralgia and neuritis, unspecified M793 Panniculitis, unspecified M794 Hypertrophy of (infrapatellar) fat pad M795 Residual foreign body in soft tissue M796 Pain in limb M798 Other specified soft tissue disorders M799 Soft tissue disorder, unspecified M80 Osteoporosis with pathological fracture M800 Postmenopausal osteoporosis with pathological fracture M801 Postoophorectomy osteoporosis with pathological fracture M802 Osteoporosis of disuse with pathological fracture M803 Postsurgical malabsorption osteoporosis with path fracture M804 Drug-induced osteoporosis with pathological fracture M805 Idiopathic osteoporosis with pathological fracture M808 Other osteoporosis with pathological fracture M809 Unspecified osteoporosis with pathological fracture M81 Osteoporosis without pathological fracture M810 Postmenopausal osteoporosis M811 Postoophorectomy osteoporosis M812 Osteoporosis of disuse M813 Postsurgical malabsorption osteoporosis M814 Drug-induced osteoporosis M815 Idiopathic osteoporosis M816 Localized osteoporosis [Lequesne] M818 Other osteoporosis M819 Osteoporosis, unspecified M82 Osteoporosis in diseases classified elsewhere M820 A Osteoporosis in multiple myelomatosis M821 A Osteoporosis in endocrine disorders M828 A Osteoporosis in other diseases classified elsewhere M83 Adult osteomalacia M830 Puerperal osteomalacia M831 Senile osteomalacia M832 Adult osteomalacia due to malabsorption
  20. 20. M833 Adult osteomalacia due to malnutrition M834 Aluminium bone disease M835 Other drug-induced osteomalacia in adults M838 Other adult osteomalacia M839 Adult osteomalacia, unspecified M84 Disorders of continuity of bone M840 Malunion of fracture M841 Nonunion of fracture [pseudarthrosis] M842 Delayed union of fracture M843 Stress fracture, not elsewhere classified M844 Pathological fracture, not elsewhere classified M848 Other disorders of continuity of bone M849 Disorder of continuity of bone, unspecified M85 Other disorders of bone density and structure M850 Fibrous dysplasia (monostotic) M851 Skeletal fluorosis M852 Hyperostosis of skull M853 Osteitis condensans M854 Solitary bone cyst M855 Aneurysmal bone cyst M856 Other cyst of bone M858 Other specified disorders of bone density and structure M859 Disorder of bone density and structure, unspecified M86 Osteomyelitis M860 Acute haematogenous osteomyelitis M861 Other acute osteomyelitis M862 Subacute osteomyelitis M863 Chronic multifocal osteomyelitis M864 Chronic osteomyelitis with draining sinus M865 Other chronic haematogenous osteomyelitis M866 Other chronic osteomyelitis M868 Other osteomyelitis M869 Osteomyelitis, unspecified M87 Osteonecrosis M870 Idiopathic aseptic necrosis of bone M871 Osteonecrosis due to drugs M872 Osteonecrosis due to previous trauma M873 Other secondary osteonecrosis M878 Other osteonecrosis M879 Osteonecrosis, unspecified M88 Paget's disease of bone [osteitis deformans] M880 Paget's disease of skull M888 Paget's disease of other bones M889 Paget's disease of bone, unspecified M89 Other disorders of bone M890 Algoneurodystrophy M891 Epiphyseal arrest M892 Other disorders of bone development and growth M893 Hypertrophy of bone M894 Other hypertrophic osteoarthropathy M895 Osteolysis M896 Osteopathy after poliomyelitis M898 Other specified disorders of bone M899 Disorder of bone, unspecified M90 Osteopathies in diseases classified elsewhere M900 A Tuberculosis of bone
  21. 21. M901 A Periostitis in other infectious diseases EC M902 A Osteopathy in other infectious diseases classified elsewhere M903 A Osteonecrosis in caisson disease M904 A Osteonecrosis due to haemoglobinopathy M905 A Osteonecrosis in other diseases classified elsewhere M906 A Osteitis deformans in neopastic disease M907 A Fracture of bone in neopastic disease M908 A Osteopathy in other diseases classified elsewhere M91 Juvenile osteochondrosis of hip and pelvis M910 Juvenile osteochondrosis of pelvis M911 Juv osteochondrosis head of femur [Legg-Calv_-Perthes] M912 Coxa plana M913 Pseudocoxalgia M918 Other juvenile osteochondrosis of hip and pelvis M919 Juvenile osteochondrosis of hip and pelvis, unspecified M92 Other juvenile osteochondrosis M920 Juvenile osteochondrosis of humerus M921 Juvenile osteochondrosis of radius and ulna M922 Juvenile osteochondrosis of hand M923 Other juvenile osteochondrosis of upper limb M924 Juvenile osteochondrosis of patella M925 Juvenile osteochondrosis of tibia and fibula M926 Juvenile osteochondrosis of tarsus M927 Juvenile osteochondrosis of metatarsus M928 Other specified juvenile osteochondrosis M929 Juvenile osteochondrosis, unspecified M93 Other osteochondropathies M930 Slipped upper femoral epiphysis (nontraumatic) M931 Kienbock's disease of adults M932 Osteochondritis dissecans M938 Other specified osteochondropathies M939 Osteochondropathy, unspecified M94 Other disorders of cartilage M940 Chondrocostal junction syndrome [Tietze] M941 Relapsing polychondritis M942 Chondromalacia M943 Chondrolysis M948 Other specified disorders of cartilage M949 Disorder of cartilage, unspecified M95 Oth acq deformities musculoskel sys and connective tis M950 Acquired deformity of nose M951 Cauliflower ear M952 Other acquired deformity of head M953 Acquired deformity of neck M954 Acquired deformity of chest and rib M955 Acquired deformity of pelvis M958 Other specified acquired deformities of musculoskel sys M959 Acquired deformity of musculoskeletal system, unspecified M96 Postprocedural musculoskeletal disorders NEC M960 Pseudarthrosis after fusion or arthrodesis M961 Postlaminectomy syndrome, not elsewhere classified M962 Postradiation kyphosis M963 Postlaminectomy kyphosis M964 Postsurgical lordosis M965 Postradiation scoliosis M966 Fract bone fllg ins orthopae implt jnt prosthesis/bone plate
  22. 22. M968 Other postprocedural musculoskeletal disorders M969 Postprocedural musculoskeletal disorder, unspecified M99 Biomechanical lesions, not elsewhere classified M990 Segmental and somatic dysfunction M991 Subluxation complex (vertebral) M992 Subluxation stenosis of neural canal M993 Osseous stenosis of neural canal M994 Connective tissue stenosis of neural canal M995 Intervertebral disc stenosis of neural canal M996 Osseous and subluxation stenosis of intervertebral foramina M997 Connective tis and disc stenosis of intervertebral foramina M998 Other biomechanical lesions M999 Biomechanical lesion, unspecified Recommendation To use ICD10 Code M00 and M99 to classify MSK and Pain Management within Specialty 410 Rhemutology. Only primary diagnosis field to be used and selection on a responsible commissioner basis. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of MSK Pain management patients and apportion to Rheumatology out patient activity. Following the Public health comment below this definition needs to be refined and discussed further. Public Health Comment: No clear what they want here I haven’t a seen a definition of what they mean by MSK. There is lots of complicated connective tissue disorders here. Many of the conditions on your list could also be seen by orthopaedics as well as rheumatology and may be other specialities as well. Is the pain management just for MSK. If not what about all cancer pain management and non M/S complaints. Seems to me that this is a difficult one to do by condition ICD code. 2.6 Coronary Heart Disease Mortality from Coronary Heart Disease is defined by the National Centre for Health Outcomes Development as ICD 10 Codes 120 to 125; I20 Angina pectoris I200 Unstable angina I201 Angina pectoris with documented spasm I208 Other forms of angina pectoris I209 Angina pectoris, unspecified I21 Acute myocardial infarction I210 Acute transmural myocardial infarction of anterior wall I211 Acute transmural myocardial infarction of inferior wall I212 Acute transmural myocardial infarction of other sites I213 Acute transmural myocardial infarction of unspecified site I214 Acute subendocardial myocardial infarction I219 Acute myocardial infarction, unspecified I22 Subsequent myocardial infarction I220 Subsequent myocardial infarction of anterior wall I221 Subsequent myocardial infarction of inferior wall I228 Subsequent myocardial infarction of other sites I229 Subsequent myocardial infarction of unspecified site I23 Certain current complication follow acute myocardial infarct I230 Haemopericardium as curr comp folow acut myocard infarct I231 Atral sept defect as curr comp folow acut myocardal infarct I232 Ventric sep defect as curr comp fol acut myocardal infarc I233 Rup cardac wal withou haemopercard as cur comp fol ac MI
  23. 23. I234 Rup chordae tendinae as curr comp fol acut myocard infarct I235 Rup papilary muscle as curr comp fol acute myocard infarct I236 Thromb atrium/auric append/vent as curr comp foll acute MI I238 Oth current comp following acute myocardial infarction I24 Other acute ischaemic heart diseases I240 Coronary thrombosis not resulting in myocardial infarction I241 Dressler's syndrome I248 Other forms of acute ischaemic heart disease I249 Acute ischaemic heart disease, unspecified I25 Chronic ischaemic heart disease I250 Atherosclerotic cardiovascular disease, so described I251 Atherosclerotic heart disease I252 Old myocardial infarction I253 Aneurysm of heart I254 Coronary artery aneurysm I255 Ischaemic cardiomyopathy I256 Silent myocardial ischaemia I258 Other forms of chronic ischaemic heart disease I259 Chronic ischaemic heart disease, unspecified Recommendation To use ICD10 Code I20 to I25 to classify Coronary Heart Disease within Specialties 170 Cardiothoracic Surgery, 320 Cardiology and 321 Paediatric Cardiology. Only primary diagnosis field to be used and selection on a responsible commissioner basis. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of Coronary Heart Disease patients and apportion to the relevant out patient specialties. Public Health Comment ICD codes I20 –I 25 are fine. 2.7 Heart Failure ICD 10 codes for Heart failure are defined as I500 to I509; I50 Heart failure I500 Congestive heart failure I501 Left ventricular failure I509 Heart failure, unspecified These codes were recognised as identifying heart failure in a paper published in 2005 “The Burden of Advanced Heart Failure -An instrument to facilitate population based needs assessment for the provision of palliative/supportive care for management of this chronic progressive disease.” By James Beattie Consultant Cardiologist Heart of England NHS Foundation Trust the findings were presented at the Circulatory Forum The National Council for Palliative Care in May 2005. Recommendation To use ICD10 Code I500 to I509 to classify Heart Failure within Specialties 170 Cardiothoracic Surgery, 320 Cardiology and 321 Paediatric Cardiology. Only primary diagnosis field to be used and selection on a responsible commissioner basis. By selecting condition data on an individual spell basis by diagnosis this will then be able to be aggregated up by HRG or specialty level. Outpatient data is impossible to map at present as this is recorded on a specialty basis not condition basis. The only option would be to calculate the % by specialty of Heart Failure patients and apportion to the relevant out patient specialties. Public Health Comment
  24. 24. Yes ICD I50 section covers it. 2.8 End of Life Care End of Life Care could be provided over several specialties for example care of the elderly, Renal ??? not just 315 Palliative Medicine but for the purpose of this exercise will be mapped to Specialty Code 315 as per NHS London’s mapping. Public Health comment I agree this is not one to do by ICD code, but Suggest you need to get advice from commissioners. 2.9 Minor procedures General Surgery and Minor procedures Gynaecology Having looked extensively there are no agreed published definitions of minor surgery for OPCS VI coding for surgical operations and procedures or Healthcare Resource Groups. The list below relates to daycase minor procedures that were classified in the Healthcare for London model that could be potentially carried out in a Polyclinic setting Some of these HRGs potentially could be mapped to General Surgery/Gynaecology. Before these are agreed I would like a Clinical opinion as to whether these HRGs can be mapped to minor procedures and if Public Health are aware if any other methods that could be used. Following the Public health comment below this definition needs to be refined and discussed further. Public Health Comment Yes I can find no useful definition of minor surgery: they seem to be circular - minor surgery is surgery is minor. Of course what is minor to one person is not to another. There is a list of GP minor surgery for reimbursement purposes covering things like joint injections and aspirations, incisions and excisions and cautery mainly for skin lesions, which I guess is covered by most of these. The only other thing I could find is an DH operational guide for day surgery which does have a number of lists you might want to look at. Again commissioning might have a better idea of what counts as minor surgery. I can go through the below with you if you want. C06 Minor Medical Head, Neck or Ear Diagnoses >69 or w cc C07 Minor Medical Head, Neck or Ear Diagnoses <70 w/o cc H22 Minor Procedures to the Musculoskeletal System H41 Sprains, Strains, or Minor Open Wounds >69 or w cc H42 Sprains, Strains, or Minor Open Wounds <70 w/o cc H63 Head Injury >69 or w cc H64 Head Injury <70 w/o cc J36 Minor Skin Procedures - Category 1 w cc J37 Minor Skin Procedures - Category 1 w/o cc J43 Major Skin Tumours J44 Minor Dermatological Conditions or Benign Tumours J45 Minor Skin Infections L20 Bladder Minor Endoscopic Procedure w cc L21 Bladder Minor Endoscopic Procedure w/o cc L22 Bladder or Urinary Mechanical Problems >69 or w cc L23 Bladder or Urinary Mechanical Problems <70 w/o cc L30 Prostate or Bladder Neck Minor Endoscopic Procedure (Male and Female) L41 Vasectomy Procedures L45 Extracorporeal Lithotripsy M09 Threatened or Spontaneous Abortion S34 Other Procedures and Health Care Problems
  25. 25. 2.10 Summary of definitions to be used Condition Codes to be used to identify the data SUS Fields to be used to select crireria Specialty to Select Basis Stroke ICD 10 160 to 69 Primary Diagnosis Field Only Neurology Responsible Commissioner COPD ICD 10 J40 to J44 Primary Diagnosis Field Only General Medicine Responsible Commissioner Asthma ICD 10 J45 and J46 Primary Diagnosis Field Only General Medicine Responsible Commissioner Diabetes ICD 10 E10 to E14 Primary Diagnosis Field Only Endocrinology/Diabetic Medicine Responsible Commissioner MSK and Pain Management ICD 10 M00 to M99 Primary Diagnosis Field Only Rhematology Responsible Commissioner Coronary Heart Disease ICD 10 I20 to I25 Primary Diagnosis Field Only Cardiothoracic Surgery, Cardiology and Paediatric Cardiology Responsible Commissioner Heart Failure ICD I500 to I509 Primary Diagnosis Field Only Cardiothoracic Surgery, Cardiology and Paediatric Cardiology Responsible Commissioner Minor Procedures General Surgery To be confirmed HRG 3.5 Code General Surgery Responsible Commissioner Minor Procedures Gynaecology To be confirmed HRG 3.5 Code Gynaecology Responsible Commissioner

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