Data and Business Rules – Amendments – Version 22.0
Author / NHS IC – QOF Business Rules team / Version No / 1.0 / Version Date / 12/12/2011

New GMS Contract QOF Implementation

Dataset and Business Rules

-

Amendments – Version 22.0

Amendment History:

Version / Date / Amendment History
1.0 / 12-December-2011 / NHS IC – QOF Business Rules team
Data and Business Rules – Amendments – Version 22.0
Author / NHS IC – QOF Business Rules team / Version No / 1.0 / Version Date / 12/12/2011

Dataset and Business Rules v22.0 – Amendments

Notes

This document is designed to help individuals working with the QOF rulesets establish the changes from version 21.0 to 22.0. The Business Rules version 22.0 should be used to implement any amendments to software.

Changes can be made to the register definitions and the cluster definitions these are described in the document under the different coding systems: Read V2 and CTV3

Page 1 of 53

Data and Business Rules – Amendments – Version 22.0
Author / NHS IC – QOF Business Rules team / Version No / 1.0 / Version Date / 12/12/2011

Contents

Dataset and Business Rules v22.0 – Amendments

General – applied to all rulesets

Asthma

Indicator renumbered

Indicator replacement

Patient Register

Read V2

CTV3

Code Clusters

Qualifying Criteria

Read V2

CTV3

Additional notes

Atrial Fibrillation

Indicator retired

Indicator replacement

New Indicator introduced

Code Clusters

Read V2

CTV3

Cancer

Patient Register

CTV3

Code Clusters

CTV3

CHD

Indicator retired

Indicator reworded

Code Clusters

Read V2

CTV3

Additional Notes

CKD

Indicator reworded

Code Clusters

CTV3

COPD

Code Clusters

Read V2

CTV3

CVD PP

Indicator reworded

Patient Register

Read V2

CTV3

Additional Notes

Cytology

Indicator reworded

Code Clusters

CTV3

Dementia

Indicator replacement

Code Clusters

Read V2

CTV3

Depression

Indicator replacement

Patient Register

Read V2

CTV3

Code Clusters

Qualifying Criteria

Read V2

CTV3

Additional Notes

Diabetes

Indicator replacement

Indicator reworded

Patient Register

Read V2

CTV3

Code Clusters

Read V2

CTV3

Additional Notes

Epilepsy

Heart Failure

Hypertension

Code Clusters

CTV3

Learning Disabilities

Mental Health

Indicator replacement

Indicator reworded

Code Clusters

Read V2

CTV3

Obesity

Osteoporosis: Secondary Prevention of Fragility Fractures

PAD

Palliative Care

Records

Indicator reworded

Indicator moved into different domain

Code Clusters

Read V2

CTV3

Sexual Health

Indicator reworded

Smoking

Indicator replacement

Indicator moved in from different domain

New Indicator introduced

Patient Register

Read V2

CTV3

Code Clusters

Read V2

CTV3

Stroke

Indicator reworded

Patient Register

Read V2

CTV3

Code Clusters

Read V2

CTV3

Additional Notes

Thyroid

General – applied to all rulesets

The words '...in the previous...' changed to '...in the preceding...' throughout in the interests of consistency.

Asthma

Indicator renumbered

ASTHMA 3 becomes ASTHMA 10

Indicator ASTHMA 3: The percentage of patients with asthma between the ages of 14 and 19 years in whom there is a record of smoking status in the preceding 15 months

Amended to

Indicator ASTHMA 10: The percentage of patients with asthma between the ages of 14 and 19 years in whom there is a record of smoking status in the preceding 15 months

Indicator ASTHMA 3 renumbered to ASTHMA 10 due to change to denominator rules to allow for patients with a smoking exception code to be excepted from the indicator if they do not meet the success criterion

Indicator replacement

Indicator ASTHMA 6 replaced by new Indicator ASTHMA 9

Indicator ASTHMA 6: The percentage of patients with asthma who have had an asthma review in the preceding 15 months.

Replaced by

Indicator ASTHMA 9: The percentage of patients with asthma who have had an asthma review in the preceding 15 months that includes an assessment of asthma control using the 3 RCP questions

Patient Register

Read V2
  • Asthma diagnostic code status updated to include this additional code following a review of the cluster:
  • H3120 – “Chronic asthmatic bronchitis”
CTV3
  • Asthma diagnostic code status updated to include this additional code following a review of the cluster. This has been achieved through removing the below code from the excluded codes list:
  • Xa0lZ – “Asthmatic bronchitis”

Code Clusters

Qualifying Criteria
  • Change to cluster REV_COD (Asthma review codes) and associated date to allow an array of codes to be picked up:

From:

Latest < REF_DAT

To:

ALL >= (REF_DAT – 15 months)

AND < REF_DAT

Associated date changed to an array.

Read V2
  • New cluster RCPEXCER_COD (Asthma Exercise Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • 6635. – “Increasing exercise wheeze”
  • 663P. – “Asthma limiting activities”
  • 663Q. – “Asthma not limiting activities”
  • 663e. – “Asthma restricts exercise”
  • 663e0 – “Asthma sometime restr exercise”
  • 663e1 – “Asthma severely restr exercise”
  • 663f. – “Asthma never restrcts exercise”
  • 663w. – “Asthm limits walk hills/stairs”
  • 663x. – “Asthma limits walking on flat”
  • New cluster RCPSLP_COD (Asthma Sleep Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • 663N. – “Asthma disturbing sleep”
  • 663N0 – “Asthma causing night waking”
  • 663N1 – “Asthma disturbs sleep weekly”
  • 663N2 – “Asthma disturbs sleep freqntly”
  • 663O. – “Asthma not disturbing sleep”
  • 663O0 – “Asthma never disturbs sleep”
  • 663r. – “Asthma night symp 1-2 per mth”
  • 66YP. – “Asthma night-time symptoms”
  • 66Ys. – “Asthma never caus night symptm”
  • New cluster RCPDSYMP_COD (Asthma Day Symptom Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • 663q. – “Asthma daytime symptoms”
  • 663s. – “Asthma never causes day symps”
  • 663t. – “Asthma day symp 1-2 per mth”
  • 663u. – “Asthma day symp 1-2 per week”
  • 663v. – “Asthma daytime symps most days”
  • New cluster SMOKASTEXC_COD (Smoking exception reporting codes) and associated date cluster added to facilitate Indicator ASTHMA 10:
  • 137k. – “Refusal to give smoking status”
  • AST_COD updated to include this additional code following a review of the cluster:
  • H3120 – “Chronic asthmatic bronchitis”
  • Existing QOF cluster SPEX_COD (Spirometry exception codes) and associated date cluster added to facilitate Indicator ASTHMA 8:
  • 33720 – “Unable to perform spirometry”
  • 8I2j. – “Spirometry contraindicated”
  • 8I3b. – “Spirometry test declined”
  • 8I6L. – “Spirometry not indicated”
CTV3
  • New cluster RCPEXCER_COD (Asthma Exercise Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • 6635. – “Increasing exercise wheeze”
  • 663e. – “Asthma restricts exercise”
  • 663f. – “Asthma never restrcts exercise”
  • 663P. – “Asthma limiting activities”
  • 663Q. – “Asthma not limiting activities”
  • 663e0 – “Asthma sometime restr exercise”
  • 663e1 – “Asthma severely restr exercise”
  • XaINf – “Asthm limits walk hills/stairs”
  • XaINg – “Asthma limits walking on flat”
  • New cluster RCPSLP_COD (Asthma Sleep Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • 663N. – “Asthma disturbing sleep”
  • 663N0 – “Asthma causing night waking”
  • 663O0 – “Asthma never disturbs sleep”
  • 663N1 – “Asthma disturbs sleep weekly”
  • 663N2 – “Asthma disturbs sleep freqntly”
  • 663O. – “Asthma not disturbing sleep”
  • XaINZ – “Asthma night symp 1-2 per mth”
  • XaIoE – “Asthma night-time symptoms”
  • XaY2V – “Asthma never caus night symptm”
  • New cluster RCPDSYMP_COD (Asthma Day Symptom Codes) and associated date cluster added to facilitate Indicator ASTHMA 9:
  • XaINa – “Asthma never causes day symps”
  • XaINb – “Asthma day symp 1-2 per mth”
  • XaINc – “Asthma day symp 1-2 per week”
  • XaIIZ – “Asthma daytime symptoms”
  • XaINd – “Asthma daytime symps most days”
  • New cluster SMOKASTEXC_COD (Smoking exception reporting codes) and associated date cluster added to facilitate Indicator ASTHMA 10:
  • XaPyn– “Refusal to give smoking status”
  • AST_COD updated to include this additional code following a review of the cluster. This has been achieved through removing the below code from the excluded codes list:
  • Xa0lZ – “Asthmatic bronchitis”
  • Existing QOF cluster SPEX_COD (Spirometry exception codes) and associated date cluster added to facilitate Indicator ASTHMA 8:
  • XaXlR – “Unable to perform spirometry”
  • XaK27 – “Spirometry test declined”
  • XaK2A – “Spirometry not indicated”
  • XaWPN – “Spirometry contraindicated”

Additional notes

  • New exception rule introduced to ASTHMA 8:

Rule 5: If SPEX_DAT >= (REF_DAT – 15 months)

  • New exception rule introduced to ASTHMA 10 to allow for patients with a smoking exception code to be excepted from the indicator if they do not meet the success criterion:

Rule 4: If SMOKASTEXC_DAT >= (REF_DAT – 15 months)

Atrial Fibrillation

Indicator retired

Indicator AF 4: The percentage of patients with atrial fibrillation diagnosed after 1 April 2008 with ECG or specialist confirmed diagnosis

Indicator replacement

Indicator AF 3 replaced by new Indicators AF 6 and AF 7

Indicator AF 3: The percentage of patients with atrial fibrillation who are currently treated with anti-coagulant drug therapy or an anti-platelet therapy

Replaced by

Indicator AF6: In those patients with atrial fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anti- coagulation drug therapy or anti-platelet therapy.

And

Indicator AF7: In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation therapy

New Indicator introduced

Indicator AF5: The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)

Code Clusters

Read V2
  • AFIBDI_COD (and associated date cluster)removed. The retirement of Indicator AF 4 means that this cluster is no longer required:
  • 3272.– “ECG: atrial fibrillation”
  • 8H41. – “General medical referral”
  • 8H44. – “Cardiological referral”
  • 8H4R. – “Ref to cardio spec interest GP”
  • 8HR1. – “Refer for ECG recording”
  • 8HTy. – “Referral to AF clinic”
  • 8HVJ. – “Private referral cardiology”
  • New cluster CHAD_COD (Stroke risk assessment using CHADS2) and associated date and value clusters added to facilitate Indicators AF 5, AF 6 and AF 7:
  • 38DE. – “CHADS2 risk score”
  • DIPY_COD (Dipyridamole prescription codes) corrected to that the exclusion codes are listed next to the correct parent:

From:

bu1..%

bu4..% (excluding bu13., bu1z.)

To:

bu1..% (excluding bu13., bu1z.)

bu4..%

CTV3
  • AFIBDI_COD (and associated date cluster)removed. The retirement of Indicator AF 4 means that this cluster is no longer required:
  • 3272. – “ECG: atrial fibrillation”
  • 8H41. – “General medical referral”
  • 8H44. – “Referral to cardiology service”
  • 8HR1. – “Refer for ECG recording”
  • XaBTR – “Referral to cardiologist”
  • 8HVJ. – “Private referral cardiologist”
  • XaLFu – “Ref to cardio spec interest GP”
  • XaXrZ – “Referral to AF clinic”
  • New cluster CHAD_COD (Stroke risk assessment using CHADS2) and associated date and value clusters added to facilitate Indicators AF 5, AF 6 and AF 7:
  • XaP9J – “CHADS2 risk score”
  • DIPY_COD (Dipyridamole prescription codes) corrected to that the exclusion codes are listed next to the correct parent:

From:

bu1..%

bu4..% (excluding bu1z.%)

To:

bu1..% (excluding bu1z.%)

bu4..%

Cancer

Patient Register

CTV3
  • Diagnostic codes updated to excludethe below code from the hierarchy X78ef% following a review of the cluster:
  • X00Z9– “Basal cell carcinoma of eyelid”

Code Clusters

CTV3
  • CAN_COD updated toexclude the below code from the hierarchy X78ef% following a review of the cluster:
  • X00Z9– “Basal cell carcinoma of eyelid”

CHD

Indicator retired

Indicator CHD 13: For patients with newly diagnosed angina (diagnosed after 1 April 2011), the percentage who are referred for specialist assessment

Indicator reworded

Minor wording change to Indicator CHD 9

Indicator CHD 9: The percentage of patients with coronary heart disease with a record in the preceding 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side effects are recorded)

Amended to

Indicator CHD 9: The percentage of patients with coronary heart disease with a record in the preceding 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken

Minor wording change to Indicator CHD 10

Indicator CHD 10: The percentage of patients with coronary heart disease who are currently treated with a beta-blocker (unless a contraindication or side effects are recorded)

Amended to

Indicator CHD 10: The percentage of patients with coronary heart disease who are currently treated with a beta-blocker

Minor wording change to Indicator CHD 14

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)

Amended to

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

Code Clusters

Read V2
  • ANG_COD (and associated date cluster)removed. The retirement of Indicator CHD 13 means that this cluster is no longer required.
  • CHDRFRL_COD (and associated date cluster)removed. The retirement of Indicator CHD 13 means that this cluster is no longer required.
  • CHOL_COD (and associated date and value clusters)removed. The introduction of the new CHOL2 clusters means that these clusters are no longer required.
  • New cluster, CHOL2_COD (Total cholesterol codes with a value) and associated date and value clusters, consisting of the codes below added to allow the selection of only those codes with a value:
  • 44OE.– “Plasma total cholesterol level”
  • 44P.. – “Serum cholesterol”
  • 44PH. – “Total cholesterol measurement”
  • 44PJ. – “Serum total cholesterol level”
  • FLU_COD cluster updated following a review to now consist of:
  • n47..% (Excluding n47A., n47B., n47r., n47s., n47t.)

65ED., 65E20

  • TXFLU_COD cluster updated following a review to now consist of:
  • 68NE.

9OX51

8I2F0

8I6D0

CTV3
  • ANG_COD (and associated date cluster)removed. The retirement of Indicator CHD 13 means that this cluster is no longer required.
  • CHDRFRL_COD (and associated date cluster)removed. The retirement of Indicator CHD 13 means that this cluster is no longer required.
  • CHOL_COD (and associated date and value clusters)removed. The introduction of the new CHOL2 clusters means that these clusters are no longer required.
  • BP_COD updated to exclude the below invasive blood pressure codes. This has been achieved by excluding the hierarchy X779b% from the hierarchy X773t%:
  • X779R– “Invasive systol arterial press”
  • X779T – “Invasive diastol arter pressur”
  • X779W– “Invasive mean arterial press”
  • X779b– “Invasive arterial pressure”
  • New cluster, CHOL2_COD (Total cholesterol codes with a value) and associated date and value clusters, consisting of the codes below added to allow the selection of only those codes with a value:
  • XE2eD – “Serum cholesterol level”
  • XaFs9 – “Fasting cholesterol level”
  • XaIRd – “Plasma total cholesterol level”
  • XaIqd – “Pre-treatmnt serum cholest lev”
  • XaJe9 – “Serum total cholesterol level”
  • FLU_COD cluster updated following a review to now consist of:
  • n47..% (Excluding n47A., n47B., n47r., n47s., n47t.)

XaZ0d, XaZ0e

  • TXFLU_COD cluster updated following a review to now consist of:
  • 68NE.

XaZ0i

XaZ0j

XaZ0k

Additional Notes

  • In the Indicator CHD 8 Denominator Rule 1 has changed to use the new CHOL2 clusters:

From:

If CHOL_VAL <= 5 AND

If CHOL_DAT >= (REF_DAT – 15 months)

To:

If CHOL2_VAL <= 5 AND

If CHOL2_DAT >= (REF_DAT – 15 months)

  • In the Indicator CHD 8 Numerator Rule 1 has changed to use the new CHOL2 clusters:

From:

If CHOL_VAL <= 5 AND

If CHOL_DAT >= (REF_DAT – 15 months)

To:

If CHOL2_VAL <= 5 AND

If CHOL2_DAT >= (REF_DAT – 15 months)

Page 1 of 53

Data and Business Rules – Amendments – Version 22.0
Author / NHS IC – QOF Business Rules team / Version No / 1.0 / Version Date / 12/12/2011

CKD

Indicator reworded

Minor wording change to Indicator CKD 1

Indicator CKD 1: The practice can produce a register of patients aged 18 years and over with CKD. (US National Kidney Foundation: Stage 3 - 5 CKD)

Amended to

Indicator CKD 1: The practice can produce a register of patients aged 18 years and over with CKD. (US National Kidney Foundation: Stage 3 to 5 CKD)

Minor wording change to Indicator CKD 5

Indicator CKD5: The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (unless a contraindication or side effects are recorded)

Amended to

Indicator CKD 5: The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an angiotensin converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB)

Code Clusters

CTV3
  • BP_COD updated to exclude the below invasive blood pressure codes. This has been achieved by excluding the hierarchy X779b% from the hierarchy X773t%:
  • X779R– “Invasive systol arterial press”
  • X779T – “Invasive diastol arter pressur”
  • X779W– “Invasive mean arterial press”
  • X779b– “Invasive arterial pressure”

COPD

Code Clusters

Read V2
  • FLU_COD cluster updated following a review to now consist of:
  • n47..% (Excluding n47A., n47B., n47r., n47s., n47t.)

65ED., 65E20

  • TXFLU_COD cluster updated following a review to now consist of:
  • 68NE.

9OX51

8I2F0

8I6D0

CTV3
  • FLU_COD cluster updated following a review to now consist of:
  • n47..% (Excluding n47A., n47B., n47r., n47s., n47t.)

XaZ0d, XaZ0e

  • TXFLU_COD cluster updated following a review to now consist of:
  • 68NE.

XaZ0i

XaZ0j

XaZ0k

CVD PP

Indicator reworded

Minor wording change to Indicator PP 1

Indicator PP 1: In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset of diagnosis (within three months of the initial diagnosis) using an agreed risk assessment treatment tool

Amended to

Indicator PP 1: In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool

Minor wording change to Indicator PP 2

Indicator PP 2: The percentage of people diagnosed with hypertension (diagnosed after 1 April 2009) who are given lifestyle advice in the preceding 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet

Amended to

Indicator PP 2: The percentage of patients diagnosed with hypertension (diagnosed after 1 April 2009) who are given lifestyle advice in the preceding 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet

Patient Register

Read V2
  • Diagnostic code for TIA diagnosis codes updated toexclude the below code following a review of the cluster:
  • F4236– “Amaurosis fugax”
  • Diagnostic code for Diabetes diagnostic codes updated following a review of the cluster to now consist of:
  • C10..

C109J

C109K

C10C.

C10D.

C10E.%

C10F.% (Excluding C10F8)

C10G.%

C10H.%

C10M.%

C10N.%

CTV3
  • Diagnostic code for TIA diagnosis codes updated toexclude the below code following a review of the cluster. This has been achieved through excluding the code from the XE0VK% hierarchy:
  • F4236– “Amaurosis fugax”
  • Diagnostic code for Diabetes diagnostic codes updated following a review of the cluster to now consist of:
  • C10..

XaOPu

XaOPt

X40J4% (Excluding L1805)

X40J5% (Excluding L1806)

X40J6

X40JA% (Excluding XSETI%, C11y0%)

X40JG% (Excluding X40JK)

C1010

C1011

C1030

C1031

XaIrf

X40JZ

XSETp

XM1Xk%

  • Diagnostic code for PVD diagnostic codes updated to exclude the below code following a review of the cluster:
  • XaVyB– “History of PVD”

Additional Notes

  • Indicator PP2 – correction made to additional notes explaining how Denominator Rule 1 is working

Cytology

Indicator reworded

Minor wording change to Indicator CS 1

Indicator CS 1: 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) whose notes record that a cervical screening test has been performed in the preceding 5 years