Implementation Guidance for the Interim National Clinical Imaging Procedure Code Set
NPFIT-NCR-DES-1087.0126/01/2007 v1.0
Implementation Guidance for the Interim National Clinical Imaging Procedure Code Set
Amendment History:
0.1 / First draft for internal review
0.2 / 21/12/2006 / Amended after internal review
1.0 / 26/01/2007 / Final amendments prior to release
Forecast Changes:
Anticipated Change / WhenReviewers:
This document must be reviewed by the following:<author to indicate reviewers>
Name / Signature / Title / Responsibility / Date / VersionPaul Richards / Terminology Author
Diagnostic Imaging Management Group / Various
Peter Simpson (suggested) / PACS technical architect
Paul Stitt (suggested) / CAB technical architect
Approvals:
This document must be approved by the following: <author to indicate approvers>
Name / Signature / Title / Responsibility / Date / VersionKen Lunn / Head of Data Standards and Products and Comms and Messaging
Paul Jones / Chief Technical Officer
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Whilst this document may be printed, the electronic version maintained in FileCM is the controlled copy. Any printed copies of the document are not controlled.
Related Documents:
These documents will provide additional information.
Ref no / Doc Reference Number / Title / Version1 / NPFIT-SHR-QMS-PRP-0015 / Glossary of Terms Consolidated.doc / <enter latest>
Glossary of Terms:
List any new terms created in this document. Mail the NPO Quality Manager to have these included in the master glossary above [1].
Term / Acronym / DefinitionContents
1About this Document
1.1Purpose
1.2Audience
1.2.1National Programme for IT in the NHS (NPfIT)
1.2.2Existing Systems
2Background
2.1.1Prior imaging procedure lists
2.1.2New interim national clinical imaging procedure code set
2.1.3Relationship to SNOMED CT
3Release Mechanism and Updates
3.1Distribution
3.2Update frequency
3.3Requests for change
4Technical Considerations
4.1Migration from existing code sets
4.1.1Migration to the new national code set from a local code set
4.1.2Migration to the new national code set from the ‘v2.0’ code set
4.1.3Timing of migration to the new national interim representation
4.2Mapping Procedure Codes
4.2.1Mapping to existing procedure codes and descriptions
4.2.2Mapping to SNOMED CT
4.2.3Mapping codes to Korner codes
4.2.4Mapping for KH12 returns
4.2.5Mapping to Imaging Acquisition Protocols
5Clinical and Business considerations
5.1Local Implementation Guidance
5.1.1Local Tailoring
5.1.2Administrative Procedures
5.1.3Laterality
5.1.4Contrast
5.1.5Multi-modality examinations
5.1.6Multi-body part examinations
5.1.7Imaging to support interventional procedures
5.1.8Procedures with unspecified body site
5.1.9Import and Review of Outside Imaging
5.1.10Non-clinical imaging procedures
© Crown Copyright 2018Page 1 of 15
Implementation Guidance for the Interim National Clinical Imaging Procedure Code Set
NPFIT-NCR-DES-1087.0126/01/2007 v1.0
1About this Document
1.1Purpose
This document is to support the implementation of a new standard list of National Clinical Imagingprocedure code set and descriptions.
The list can be found in Excel format in the document “National interim descriptions for ClinicalImaging Procedures” NPFIT-NCR-DES-1091.01.
The principles on which it is based can be found in the word document “National Interim Standard Descriptions for Clinical Imaging Procedures to support PACS/RIS implementations” NPFIT-NCR-DES-1076.01.
This implementation guidance has been created to assistsites with migration to the national clinical imaging procedure code set, and provide guidance to address specificimplementation issues on how the codes should be used in practice. It is intended to be iterative and will address new issues as they are identified and will be updated in accordance with the future release schedule.
The guidance is not intended to describe system behaviour or message population for the standard HL7v3 messages to the Summary Care Record.
1.2Audience
This document has been written for those suppliers and NHS designers working to configure applications used in the Clinical Imaging domain
1.2.1National Programme for IT in the NHS (NPfIT)
There are two main work-streams of the NPfIT that are expected to utilise the new National code set from the outset. These are the National Care Record Service (NCRS) and the Picture Archiving and Communication Programme (PACS). It is anticipated that other workstreams such as the Secondary Uses Service (SUS) and Choose and Book (CaB) will be able to make use of the code set in the medium term. The list will also support other initiatives such as payment by results and the 18 week waiting time targets
The NCRS will comprise a mix of national and local IT services designed to provide a cradle-to-grave NHS Care Record for each patient, which will transcend traditional care organisations' boundaries.
The PACS programme will deliver applications to support the creation and sharing of digital images and reports across healthcare communities.
The adoption of common standards, including procedure codes, is an essential requirement to enable full interoperability between systems. In the NCRS and PACS, it is recommended the national clinical imaging procedure codeset isimplemented in the following clinical systems:
- Electronic Remote Requesting (ordercomms)
- RIS
- Imaging modalities
- PACS
- Result Reporting and Acknowledgement
1.2.2Existing Systems
The SNOMED CT Clinical Imaging Procedures Subset Management Group recommend the national clinical imaging procedure code set is used in all integrated clinical application systems. This approach is endorsed by all stakeholders including the Royal College of Radiologists, British Nuclear Medicine Society, British Medical Association, Royal College of General Practitioners, the Society of Radiographers, the Department of Health, NHS Connecting for Health and representatives of the other home countries.
.
2Background
2.1.1Prior imaging procedure lists
Historically, imaging departments have developed their own set of procedure codes to support their local operational and business requirements. Research has shown a lot of commonality between these lists, but there is alsosignificant variance as the lists have evolved to meet local requirements. Whilst this diversity provides local flexibility, it has become an obstacle to wider system integration and interoperability, and limits the ability for sites to collate data across healthcare providers.
In response to this challenge, a number of stakeholders, including the Royal College of Radiologists (RCR),NPfIT and Local Service Providers (LSPs), collaborated to produce a common set of procedure codes and descriptions to support initialdeployments in the Connecting for Health PACS programme. This list is referred to as CRS Radiology Catalogue v2.0 (Examination Code Set), NPFIT-LON-LBP-0228.06, or more commonly just as the v2.0 code set. This list has formed the basis of the National code set and now includes additional content and a greater degree of editorial stringency and consistency but follows the same format for the code creation.
This implementation guidance is intended both for those adopting this type of list for the first time and for those moving from the v2.0 code set.
2.1.2New interim national clinical imaging procedure code set
The new national code set has been developed as a collaborative effort with formal management arrangements and the participation of all known major stakeholders.
A group has been established to oversee the developments – the Clinical Imaging Procedures Management Group (CIMG).This management group reports into the Department of Health National Imaging Board via the National Clinical Lead for Imaging.
The Editorial principles applied in the creation of this list are described in the document “National Interim Standard Descriptions for Clinical Imaging Procedures to support PACS/RIS implementations”, File-CM reference NPFIT-NCR-DES-1076.01.
The list itself, released in November 2006 is documented in Excel format in the document “National interim codes and descriptions for ClinicalImaging Procedures”, with File-CM referenceNPFIT-NCR-DES-1091.01.
2.1.3Relationship to SNOMED CT
The new ‘interim’ national clinical imaging procedure code set is designed to bridge the gap until all clinical systems can natively support SNOMED Clinical Terms (CT), and whilst additional concepts are introduced into SNOMED CT to fully support UK clinical imaging practice. In time, when all clinical systems are utilisingSNOMED CT, it is anticipated that the representation of DI procedures in NCRS applications will be entirely by the use of SNOMED CTcoded concepts.
3ReleaseMechanism and Updates
The descriptions have been designed to be a maximum of 40 characters to enable use in the existing systems that have this constraint.
The meaningful code that has been developed for each entry is constructed according to a pattern described in section 4.5 of the Editorial Principles document
3.1Distribution
The interim national clinical imaging procedure code set and supporting documents, including this implementation guidance, will be distributed via the formal NHS CfH mechanisms to LSPs and will be hosted on an ftp server for other suppliers and interested parties.
A user name and password will be available by application from the Data Standards Helpdesk ()In order to utilise the mappings to SNOMED CT, all recipients must be SNOMED CT license holders.
A version without the SNOMED CT mappings will be available from various websites included the Society of Radiographers, the Royal College of Radiologists and NHS Connecting for Health.
3.2Update frequency
The first release of the National code set is planned for January 26th 2007. The code set will be updated to reflect the dynamism of clinical practice and will be integrated with the NCRS mandated standards for interoperability, SNOMED CT in due course. As such it is anticipated that the next version will be released at the same time as the October 2007 SNOMED CT release. This implementation guidance will be updated periodically to coincide with releases of the national code set.
3.3Requests for change
Until now, requests for additions and change to the national code set have been posted to the RCR PACS and Teleradiology website,or submitted informally to known individuals.
Future requests for change or notifications of errors should be submitted on the standard proforma to the NHS Connecting for Health Data Standards helpdesk – . This proforma will be distributed to stakeholders and LSPS, and will be available on an ftp server andthe RCR PACS and Teleradiology website.
Submissions will be directed to the appropriate level of support and requestors should ensure that the fact that it is an Interim Clinical Imaging Procedure enquiry be clearly communicated to the operator.
Limited resources are available to make changes so all requests will be prioritised according to guidelines established by the CIMG. Requests for change to the implementation guidance should be submitted through stakeholder representatives on the CIMG.
Deadlines for both individual and batch submissions will be published on the NHS CfH Data Standards website prior to the subsequent release in October 2007.
4Technical Considerations
4.1Migration from existing code sets
4.1.1Migration to the new national code set from a local code set
It is recommended that all clinical imaging centres in the UK adopt the new national code set. This will inevitably require the replacement of any current local procedure codes.
It is a local decision whether to attempt to map the former code system to the new National representation – to aid analysis of old and new data together for instance – or whether to end date (retire) all existing codes and start afresh with the new national codes. In either case, only the approved national code set should be used for new data entry (see section 4.2.1on mapping existing procedure codes)
4.1.2Migration to the new national code set from the ‘v2.0’ code set
In the development of the new representation a number of anomalies were identified in the v2.0 list, these should be corrected in the new representation which is based on it.
This will result in some entries being changed and others being retired.
It is important to note that where a minor change has been required to a v2.0 description to comply with editorial principles, the same code will continue to be used with the new description.
To assist with the migration process, all old codes and descriptions will be maintained and linked to their replacements.
There have also been a number of new procedures added as well as new synonyms.
It is a matter for the local implementers to decide which of the available descriptions to make available to their local users. It is also possible to introduce additional local descriptions as long as they are linked to the National codes and descriptions.
To aid understanding of why changes have been made it will be possible to request an enhanced version of the code list spreadsheet with links directly to the relevant Editorial principles. This should be requested from the Data Standards Helpdesk ().
4.1.3Timing of migration to the new national interim representation
It is recommended all sites migrate to the national code set as soon as is practicable after its release. Where systems are integrated, migration should be coordinated to enable switch over to the new data set across all systems at the same time. For strategic based services, such as the SHA based radiology information systems, this will require cooperation between all participating organisations to minimise any downtime and risk of system errors due to non-matching codes in the interfaced systems.
4.2Mapping Procedure Codes
4.2.1Mapping to existing procedure codes and descriptions
It is recommended that only the approved interim national procedure codes are used in communication between systems. Sites may implement the national procedure description or and approved synonym from the national list.
Sites may map their existing codes to the new national procedure codes. This may require a data migration exercise whereby all references to an existing code within the system are replaced with the corresponding national code. E.g. A local code C01 Chest X-raywould be updated to XCHES Chest X-raythroughout the system. If a system is capable of recording more than one procedure code per procedure, the new national code can be used in addition to the local code providing it is the national code that is used in communication with other integrated systems.
When mapping individual codes, sites should follow the local implementation guidance below (section 5.1). If there is no corresponding national procedure code, the local code should be end dated so it cannot be used for new data entry.
Any organisation wishing to retain their own local codes and descriptions should undertake a risk assessment to determine the impact on interoperability with interfaced systems, and any clinical risk that may ensue.
4.2.2Mapping to SNOMED CT
To support eventual migration from the interim national clinical imaging procedure code set to SNOMED CT, a mapping from each entry to a corresponding SNOMED CT concept is being developed by the national CIMG. The current interim mapped representation list can be obtained through the approved release mechanism route (see 3.1 above).Any request for change to the mapping should be submitted via the national route.
The current mapping of interim national procedure descriptions to SNOMED CT concepts aims to provide as close a representation as can be achieved with the current SNOMED CT data set:
Sometimes the map will be to the exact equivalent SNOMED CT concept:
Bronchogram has map to Bronchogram 418876000
Sometimes the map will be to a close approximation:
CT radiotherapy planning scan has map to CT guidance for treatment planning, teletherapy 24689001
Sometimes the map will be to a high-level, less-detailed approximation (where the interim descriptions diverge from current SNOMED CT concepts). In this situation, additional SNOMED CT concepts will be introduced to support eventual migration to SNOMED CT:
CT Arteriogram has map to Computerised tomography 77477000
There are also common attributes which are not pre-expressed in SNOMED CT and are achieved by application of additional qualifying information – such as laterality. In this case the map would be to the non-lateralised equivalent and the laterality will be post coordinated:
XR Leg Length Measurement Lt has map to Leg length measurement X-ray 299010000 and laterality Left
It is intended that all interim descriptions will have matching SNOMED CT concepts by the time systems migrate fully to using SNOMED CT, Until this mapping exercise is complete, a clinical risk assessment will need to be undertaken for any interfaces with NCRS conformant SNOMED CT encoding systems using the current mapped representation.
4.2.3Mapping codes to Korner codes
The national list includes a mapping of procedure codes to Korner codes, as documented in the NHS costing manual. Any request for change to the mapping should be submitted via the national route.
It is important to note that this mapping is indicative only and has not been formally validated, please exercise caution in use.
4.2.4Mapping for KH12 returns
Clinical Imaging departments are required to submit KH12 returns to the Department of Health. To facilitate automation of this process, each procedure in the interim representation, where appropriate, has been given a suggested map to the relevant KH12 modality grouping and body part multiplication factor for KH12 returns.
It is important to note that this mapping is indicative only and has not been formally validated, please exercise caution in use.
4.2.5Mapping to Imaging Acquisition Protocols
The national clinical imaging procedure codes are not intended to map 1:1 with imaging acquisition protocols. Acquisition protocols can vary more widely, and the protocol performed may depend on local clinician’s preferences, the patient’s diagnosis and condition, and the imaging equipment used.
Someprocedures may only have one matching acquisition protocol, but othersmap toseveral different imaging protocols. InCT scanning for example, there are a large number of different acquistion protocols covered by relatively few procedure codes e.g. CT abdo/pelvis. The imaging acquisition protocol should be determined when the requested procedure is justified, based on the full clinical information in the request. Some systems support procedure mapping enabling users to select one of a range of acquisition protocols appropriate to an imaging procedure.
5Clinical and Business considerations
5.1Local Implementation Guidance
5.1.1Local Tailoring
Many prior lists were administrated locally, with no requirement for information to be shared or collated across organisations. Administrators were able to make changes to the local list as and when the perceived need arose. The implementation of a National data set for clinical imaging procedures will prevent these local changes being made.