NHS LondonLondon World Class Commissioning Assurance Newsletter

Volume 2, August 2008

London World Class Commissioning AssuranceNewsletter, volume 2, 29 August 2008

*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 templateThis 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 leadsPlease 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.ukNWL Patricia Wright Patricia.Wright@hf-pct.nhs.ukNCL  Liz Wise  Liz.wise@camdenpct.nhs.ukSEL Tony Read Tony.read@greenwichpct.nhs.ukSWL Shirley Ann Carvill ShirleyAnne.Carvill@wpct.nhs.uk

Healthcare Market AnalysisA 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.

FAQsAn 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 Management15 September – Understanding how markets within health are defined26th September – CSP Market management and procurement strategies2nd October – Making the theoretical applicable – applying market analysis to London15th October – Translating the potential within markets to actual improvement

Venue and available spaces to be confirmed.

Organisational DevelopmentOrganisation Development Workshop will take place at the beginning of October. Date to be confirmed.

Working sessionsWe 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 PracticeHillingdon 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 DaysDates 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 MilestonesDraft 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 linksAll 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/Worldclasscommissioning/Assurance/index.htm

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

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

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 haemorrhageI600 Subarachnoid haemorrhage from carotid siphon and bifurcationI601 Subarachnoid haemorrhage from middle cerebral arteryI602 Subarachnoid haemorrhage from anterior communicating arteryI603 Subarachnoid haemorrhage from posterior communicating arteryI604 Subarachnoid haemorrhage from basilar arteryI605 Subarachnoid haemorrhage from vertebral arteryI606 Subarachnoid haemorrhage from other intracranial arteriesI607 Subarachnoid haemorrhage from intracranial artery, unspecI608 Other subarachnoid haemorrhageI609 Subarachnoid haemorrhage, unspecifiedI61 Intracerebral haemorrhageI610 Intracerebral haemorrhage in hemisphere, subcorticalI611 Intracerebral haemorrhage in hemisphere, corticalI612 Intracerebral haemorrhage in hemisphere, unspecifiedI613 Intracerebral haemorrhage in brain stemI614 Intracerebral haemorrhage in cerebellumI615 Intracerebral haemorrhage, intraventricularI616 Intracerebral haemorrhage, multiple localizedI618 Other intracerebral haemorrhageI619 Intracerebral haemorrhage, unspecifiedI62 Other nontraumatic intracranial haemorrhageI620 Subdural haemorrhage (acute)(nontraumatic)I621 Nontraumatic extradural haemorrhage

I629 Intracranial haemorrhage (nontraumatic), unspecifiedI63 Cerebral infarctionI630 Cerebral infarct due to thrombosis of precerebral arteriesI631 Cerebral infarction due to embolism of precerebral arteriesI632 Cereb infarct due unsp occlusion or stenos precerebrl artsI633 Cerebral infarction due to thrombosis of cerebral arteriesI634 Cerebral infarction due to embolism of cerebral arteriesI635 Cerebrl infarct due unspec occlusion or stenos cerebrl artsI636 Cereb infarct due cerebral venous thrombosis, nonpyogenicI638 Other cerebral infarctionI639 Cerebral infarction, unspecifiedI64X Stroke, not specified as haemorrhage or infarctionI65 Occlusion/stenos precerebral arts not result cerebrl infarctI650 Occlusion and stenosis of vertebral arteryI651 Occlusion and stenosis of basilar arteryI652 Occlusion and stenosis of carotid arteryI653 Occlusion and stenosis of multip and bilat precerebrl artsI658 Occlusion and stenosis of other precerebral arteryI659 Occlusion and stenosis of unspecified precerebral arteryI66 Occlusion/stenosis cerebral arts not result cerebral infarctI660 Occlusion and stenosis of middle cerebral arteryI661 Occlusion and stenosis of anterior cerebral arteryI662 Occlusion and stenosis of posterior cerebral arteryI663 Occlusion and stenosis of cerebellar arteriesI664 Occlusion and stenosis of multiple and bilat cerebrl artsI668 Occlusion and stenosis of other cerebral arteryI669 Occlusion and stenosis of unspecified cerebral arteryI67 Other cerebrovascular diseasesI670 Dissection of cerebral arteries, nonrupturedI671 Cerebral aneurysm, nonrupturedI672 Cerebral atherosclerosisI673 Progressive vascular leukoencephalopathyI674 Hypertensive encephalopathyI675 Moyamoya diseaseI676 Nonpyogenic thrombosis of intracranial venous systemI677 Cerebral arteritis, not elsewhere classifiedI678 Other specified cerebrovascular diseasesI679 Cerebrovascular disease, unspecifiedI68 Cerebrovascular disorders in diseases classified elsewhereI680 A Cerebral amyloid angiopathyI681 A Cerebral arteritis in infect & parasit dis classif elsewhI682 A Cerebral arteritis in other diseases classified elsewhereI688 A Other cerebrovascular disorders in diseases ECI69 Sequelae of cerebrovascular diseaseI690 Sequelae of subarachnoid haemorrhageI691 Sequelae of intracerebral haemorrhageI692 Sequelae of other nontraumatic intracranial haemorrhageI693 Sequelae of cerebral infarctionI694 Sequelae of stroke, not spec as haemorrhage or infarctionI698 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

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 ccD40 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.

Version 3.5 of Healthcare Resource Group Codes matched two codes to Asthma;

D21 Asthma w ccD22 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 mellitusE100 Insulin-dependent diabetes mellitus with comaE101 Insulin-dependent diabetes mellitus with ketoacidosisE102 Insulin-dependent diabetes mellitus with renal complicationsE102 D INSULIN DEPENDENT DIABETES MELLITUS WITH RENAL COMPLICATIONSE103 Insulin-dependent diabetes mellitus with ophthalmic compsE103 D INSULIN DEPENDENT DIABETES MELLITUS WITH OPTHALMIC COMPLICATE104 Insulin-dependent diabetes mellitus with neurological compsE105 Insulin-dependent diabetes mellitus with periph circ compsE106 Insulin-dependent diabetes mellitus with other spec compsE107 Insulin-dependent diabetes mellitus with multiple compsE108 Insulin-dependent diabetes mellitus with unspec compsE109 Insulin-dependent diabetes mellitus without complicationsE11 Non-insulin-dependent diabetes mellitusE110 Non-insulin-dependent diabetes mellitus with comaE111 Non-insulin-dependent diabetes mellitus with ketoacidosisE112 Non-insulin-dependent diabetes mellitus with renal compsE113 Non-insulin-dependent diabetes mellitus with ophthalm compsE113 D NON-INSULIN DEPENDENT DIABETES MELLITUS WITH OPTHALMIC COMPSE114 Non-insulin-dependent diabetes mellitus with neuro compsE115 Non-insulin-depend diabetes mellitus with periph circ compE116 Non-insulin-depend diabetes mellitus with other spec compE117 Non-insulin-dependent diabetes mellitus with multiple compsE118 Non-insulin-dependent diabetes mellitus with unspec compsE119 Non-insulin-depend diabetes mellitus without complicationE12 Malnutrition-related diabetes mellitusE120 Malnutrition-related diabetes mellitus with comaE121 Malnutrition-related diabetes mellitus with ketoacidosisE122 Malnutrition-related diabetes mellitus with renal comps

E123 Malnutrition-related diabetes mellitus with ophthalmic compsE124 Malnutrition-related diabetes mellitus with neuro compsE125 Malnutrition-relat diabetes mellitus with periph circ compE126 Malnutrition-relat diabetes mellitus with other spec compsE127 Malnutrition-related diabetes mellitus with multiple compsE128 Malnutrition-related diabetes mellitus with unspec compsE129 Malnutrition-related diabetes mellitus without complicationsE13 Other specified diabetes mellitusE130 Other specified diabetes mellitus with comaE131 Other specified diabetes mellitus with ketoacidosisE132 Other specified diabetes mellitus with renal complicationsE133 Other specified diabetes mellitus with ophthalmic compsE134 Other specified diabetes mellitus with neurological compsE135 Other specified diabetes mellitus with periph circ compsE136 Other specified diabetes mellitus with other spec compsE137 Other specified diabetes mellitus with multiple compsE138 Other specified diabetes mellitus with unspecified compsE139 Other specified diabetes mellitus without complicationsE14 Unspecified diabetes mellitusE140 Unspecified diabetes mellitus with comaE141 Unspecified diabetes mellitus with ketoacidosisE142 Unspecified diabetes mellitus with renal complicationsE143 Unspecified diabetes mellitus with ophthalmic complicationsE144 Unspecified diabetes mellitus with neurological compsE145 Unspecified diabetes mellitus with periph circulatory compsE146 Unspecified diabetes mellitus with other specified compsE147 Unspecified diabetes mellitus with multiple complicationsE148 Unspecified diabetes mellitus with unspecified complicationsE149 Unspecified diabetes mellitus without complicationsE15X Nondiabetic hypoglycaemic coma

Version 3.5 of Healthcare Resource Group Codes matches seven codes to Diabetes;

K11 Diabetes with Hypoglycaemic Emergency >69 or w ccK12 Diabetes with Hypoglycaemic Emergency <70 w/o ccK13 Diabetes with Hyperglycaemic Emergency >69 or w ccK14 Diabetes with Hyperglycaemic Emergency <70 w/o ccK15 Diabetes and Other Hyperglycaemic Disorder >69 or w ccK16 Diabetes and Other Hyperglycaemic Disorder <70 w/o ccK17 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.

2.5 Rheumatology (MSK and Pain management)

World Mapper website classifies deaths from Musculoskeletal disease as ICD 10 code M00 to M99;

M00 Pyogenic arthritisM000 Staphylococcal arthritis and polyarthritisM001 Pneumococcal arthritis and polyarthritisM002 Other streptococcal arthritis and polyarthritisM008 Arthritis and polyarthritis due other spec bacterial agentsM009 Pyogenic arthritis, unspecifiedM01 Direct infections joint in infectious and parasitic dis ECM010 A Meningococcal arthritisM011 A Tuberculous arthritisM012 A Arthritis in Lyme diseaseM013 A Arthritis in other bacterial diseases classified elsewhereM014 A Rubella arthritisM015 A Arthritis in other viral diseases classified elsewhereM016 A Arhritis in mycosesM018 A Arthritis in other infectious and parasitic diseases ECM02 Reactive arthropathiesM020 Arthropathy following intestinal bypassM021 Postdysenteric arthropathyM022 Postimmunization arthropathyM023 Reiter's diseaseM028 Other reactive arthropathiesM029 Reactive arthropathy, unspecifiedM03 Postinfective and reactive arthropathies in diseases ECM030 A Postmeningococcal arthritisM031 A Postinfective arthropathy in syphilisM032 A Other postinfectious arthropathies in diseases ECM036 A Reactive arthropathy in other diseases classified elsewhereM05 Seropositive rheumatoid arthritisM050 Felty's syndromeM051 D Rheumatoid lung diseaseM052 Rheumatoid vasculitisM053 D Rheumatoid arthritis with involvement of oth organs and sysM058 Other seropositive rheumatoid arthritisM059 Seropositive rheumatoid arthritis, unspecifiedM06 Other rheumatoid arthritisM060 Seronegative rheumatoid arthritisM061 Adult-onset Still's diseaseM062 Rheumatoid bursitisM063 Rheumatoid noduleM064 Inflammatory polyarthropathyM068 Other specified rheumatoid arthritisM069 Rheumatoid arthritis, unspecifiedM07 Psoriatic and enteropathic arthropathiesM070 A Distal interphalangeal psoriatic arthropathyM071 A Arthritis mutilansM072 A Psoriatic spondylitisM073 A Other psoriatic arthropathiesM074 A Arthropathy in Crohn's disease [regional enteritis]M075 A Arthropathy in ulcerative colitisM076 A Other enteropathic arthropathiesM08 Juvenile arthritisM080 Juvenile rheumatoid arthritis

M081 Juvenile ankylosing spondylitisM082 Juvenile arthritis with systemic onsetM083 Juvenile polyarthritis (seronegative)M084 Pauciarticular juvenile arthritisM088 Other juvenile arthritisM089 Juvenile arthritis, unspecifiedM09 Juvenile arthritis in diseases classified elsewhereM090 A Juvenile arthritis in psoriasisM091 A Juvenile arthritis in Crohn's disease [reg enteritis]M092 A Juvenile arthritis in ulcerative colitisM098 A Juvenile arthritis in other diseases classified elsewhereM10 GoutM100 Idiopathic goutM101 Lead-induced goutM102 Drug-induced goutM103 Gout due to impairment of renal functionM104 Other secondary goutM109 Gout, unspecifiedM11 Other crystal arthropathiesM110 Hydroxyapatite deposition diseaseM111 Familial chondrocalcinosisM112 Other chondrocalcinosisM118 Other specified crystal arthropathiesM119 Crystal arthropathy, unspecifiedM12 Other specific arthropathiesM120 Chronic postrheumatic arthropathy [Jaccoud]M121 Kaschin-Beck diseaseM122 Villonodular synovitis (pigmented)M123 Palindromic rheumatismM124 Intermittent hydrarthrosisM125 Traumatic arthropathyM128 Other specific arthropathies, not elsewhere classifiedM13 Other arthritisM130 Polyarthritis, unspecifiedM131 Monoarthritis, not elsewhere classifiedM138 Other specified arthritisM139 Arthritis, unspecifiedM14 Arthropathies in other diseases classified elsewhereM140 A Gouty arthropathy due enzym defect and oth inherit disorderM141 A Crystal arthropathy in other metabolic disordersM142 A Diabetic arthropathyM143 A Lipoid dermatoarthritisM144 A Arthropathy in amylodosisM145 A Arthropathies oth endocrine nutrition and metabol disorderM146 A Neuropathic arthropathyM148 A Arthropathies in other specified diseases ECM15 PolyarthrosisM150 Primary generalized (osteo)arthrosisM151 Heberden's nodes (with arthropathy)M152 Bouchard's nodes (with arthropathy)M153 Secondary multiple arthrosisM154 Erosive (osteo)arthrosisM158 Other polyarthrosisM159 Polyarthrosis, unspecifiedM16 Coxarthrosis [arthrosis of hip]M160 Primary coxarthrosis, bilateral

M161 Other primary coxarthrosisM162 Coxarthrosis resulting from dysplasia, bilateralM163 Other dysplastic coxarthrosisM164 Post-traumatic coxarthrosis, bilateralM165 Other post-traumatic coxarthrosisM166 Other secondary coxarthrosis, bilateralM167 Other secondary coxarthrosisM169 Coxarthrosis, unspecifiedM17 Gonarthrosis [arthrosis of knee]M170 Primary gonarthrosis, bilateralM171 Other primary gonarthrosisM172 Post-traumatic gonarthrosis, bilateralM173 Other post-traumatic gonarthrosisM174 Other secondary gonarthrosis, bilateralM175 Other secondary gonarthrosisM179 Gonarthrosis, unspecifiedM18 Arthrosis of first carpometacarpal jointM180 Primary arthrosis of first carpometacarpal joints, bilateralM181 Other primary arthrosis of first carpometacarpal jointM182 Post-traumatic arthrosis of first carpometacarpal jt bilatM183 Other post-traumatic arthrosis of first carpometacarpal jtM184 Oth sec arthrosis of first carpometacarpal joints bilateralM185 Other secondary arthrosis of first carpometacarpal jointM189 Arthrosis of first carpometacarpal joint, unspecifiedM19 Other arthrosisM190 Primary arthrosis of other jointsM191 Post-traumatic arthrosis of other jointsM192 Secondary arthrosis of other jointsM198 Other specified arthrosisM199 Arthrosis, unspecifiedM20 Acquired deformities of fingers and toesM200 Deformity of finger(s)M201 Hallux valgus (acquired)M202 Hallux rigidusM203 Other deformity of hallux (acquired)M204 Other hammer toe(s) (acquired)M205 Other deformities of toe(s) (acquired)M206 Acquired deformity of toe(s), unspecifiedM21 Other acquired deformities of limbsM210 Valgus deformity, not elsewhere classifiedM211 Varus deformity, not elsewhere classifiedM212 Flexion deformityM213 Wrist or foot drop (acquired)M214 Flat foot [pes planus] (acquired)M215 Acquired clawhand, clubhand, clawfoot and clubfootM216 Other acquired deformities of ankle and footM217 Unequal limb length (acquired)M218 Other specified acquired deformities of limbsM219 Acquired deformity of limb, unspecifiedM22 Disorders of patellaM220 Recurrent dislocation of patellaM221 Recurrent subluxation of patellaM222 Patellofemoral disordersM223 Other derangements of patellaM224 Chondromalacia patellaeM228 Other disorders of patella

M229 Disorder of patella, unspecifiedM23 Internal derangement of kneeM230 Cystic meniscusM231 Discoid meniscus (congenital)M232 Derangement of meniscus due to old tear or injuryM233 Other meniscus derangementsM234 Loose body in kneeM235 Chronic instability of kneeM236 Other spontaneous disruption of ligament(s) of kneeM238 Other internal derangements of kneeM239 Internal derangement of knee, unspecifiedM24 Other specific joint derangementsM240 Loose body in jointM241 Other articular cartilage disordersM242 Disorder of ligamentM243 Pathological dislocation and subluxation of joint NECM244 Recurrent dislocation and subluxation of jointM245 Contracture of jointM246 Ankylosis of jointM247 Protrusio acetabuliM248 Other specific joint derangements, not elsewhere classifiedM249 Joint derangement, unspecifiedM25 Other joint disorders, not elsewhere classifiedM250 HaemarthrosisM251 Fistula of jointM252 Flail jointM253 Other instability of jointM254 Effusion of jointM255 Pain in jointM256 Stiffness of joint, not elsewhere classifiedM257 OsteophyteM258 Other specified joint disordersM259 Joint disorder, unspecifiedM30 Polyarteritis nodosa and related conditionsM300 Polyarteritis nodosaM301 Polyarteritis with lung involvement [Churg-Strauss]M302 Juvenile polyarteritisM303 Mucocutaneous lymph node syndrome [Kawasaki]M308 Other conditions related to polyarteritis nodosaM31 Other necrotizing vasculopathiesM310 Hypersensitivity angiitisM311 Thrombotic microangiopathyM312 Lethal midline granulomaM313 Wegener's granulomatosisM314 Aortic arch syndrome [Takayasu]M315 Giant cell arteritis with polymyalgia rheumaticaM316 Other giant cell arteritisM318 Other specified necrotizing vasculopathiesM319 Necrotizing vasculopathy, unspecifiedM32 Systemic lupus erythematosusM320 Drug-induced systemic lupus erythematosusM321 D Systemic lupus erythematosus with organ or sys involvM328 Other forms of systemic lupus erythematosusM329 Systemic lupus erythematosus, unspecifiedM33 DermatopolymyositisM330 Juvenile dermatomyositis

M331 Other dermatomyositisM332 PolymyositisM339 Dermatopolymyositis, unspecifiedM34 Systemic sclerosisM340 Progressive systemic sclerosisM341 CR(E)ST syndromeM342 Systemic sclerosis induced by drugs and chemicalsM348 Other forms of systemic sclerosisM349 Systemic sclerosis, unspecifiedM35 Other systemic involvement of connective tissueM350 Sicca syndrome [Sjogren]M351 Other overlap syndromesM352 Behcet's diseaseM353 Polymyalgia rheumaticaM354 Diffuse (eosinophilic) fasciitisM355 Multifocal fibrosclerosisM356 Relapsing panniculitis [Weber-Christian]M357 Hypermobility syndromeM358 Other specified systemic involvement of connective tissueM359 Systemic involvement of connective tissue, unspecifiedM36 Systemic disorders of connective tissue in diseases ECM360 A Dermato(poly)myositis in neopastic diseaseM361 A Arthropathy in neopastic diseaseM362 A Haemophilic arthropathyM363 A Arthropathy in other blood disordersM364 A Arthropathy in hypersensitivity reactions ECM368 A Systemic disord of connective tissue in other diseases ECM40 Kyphosis and lordosisM400 Postural kyphosisM401 Other secondary kyphosisM402 Other and unspecified kyphosisM403 Flatback syndromeM404 Other lordosisM405 Lordosis, unspecifiedM41 ScoliosisM410 Infantile idiopathic scoliosisM411 Juvenile idiopathic scoliosisM412 Other idiopathic scoliosisM413 Thoracogenic scoliosisM414 Neuromuscular scoliosisM415 Other secondary scoliosisM418 Other forms of scoliosisM419 Scoliosis, unspecifiedM42 Spinal osteochondrosisM420 Juvenile osteochondrosis of spineM421 Adult osteochondrosis of spineM429 Spinal osteochondrosis, unspecifiedM43 Other deforming dorsopathiesM430 SpondylolysisM431 SpondylolisthesisM432 Other fusion of spineM433 Recurrent atlantoaxial subluxation with myelopathyM434 Other recurrent atlantoaxial subluxationM435 Other recurrent vertebral subluxationM436 TorticollisM438 Other specified deforming dorsopathies

M439 Deforming dorsopathy, unspecifiedM45X Ankylosing spondylitisM46 Other inflammatory spondylopathiesM460 Spinal enthesopathyM461 Sacroiliitis, not elsewhere classifiedM462 Osteomyelitis of vertebraM463 Infection of intervertebral disc (pyogenic)M464 Discitis, unspecifiedM465 Other infective spondylopathiesM468 Other specified inflammatory spondylopathiesM469 Inflammatory spondylopathy, unspecifiedM47 SpondylosisM470 D Ant spinal and vertebral artery compression syndromesM471 Other spondylosis with myelopathyM472 Other spondylosis with radiculopathyM478 Other spondylosisM479 Spondylosis, unspecifiedM48 Other spondylopathiesM480 Spinal stenosisM481 Ankylosing hyperostosis [Forestier]M482 Kissing spineM483 Traumatic spondylopathyM484 Fatigue fracture of vertebraM485 Collapsed vertebra, not elsewhere classifiedM488 Other specified spondylopathiesM489 Spondylopathy, unspecifiedM49 Spondylopathies in diseases classified elsewhereM490 A Tuberculosis of spineM491 A Brucella spondylitisM492 A Enterobacterial spondylitisM493 A Spondylopathy in other infectious and parasitic dis ECM494 A Neuropathic spondylopathyM495 A Collapsed vertebra in diseases classified elsewhereM498 A Spondylopathy in other diseases classified elsewhereM50 Cervical disc disordersM500 D Cervical disc disorder with myelopathyM501 Cervical disc disorder with radiculopathyM501 D CERVICAL DISC DISORDER WITH RADICULOPATHYM502 Other cervical disc displacementM503 Other cervical disc degenerationM508 Other cervical disc disordersM509 Cervical disc disorder, unspecifiedM51 Other intervertebral disc disordersM510 D Lumbar and other intrvertbrl disc disord with mylopathyM511 Lumb and oth intrvertbrl disc disorders with radiculopathyM511 D LUMBAR AND OTHER INTERVERTABRAL DISC DISORDERS WITH RADICULOM512 Other specified intervertebral disc displacementM513 Other specified intervertebral disc degenerationM514 Schmorl's nodesM518 Other specified intervertebral disc disordersM519 Intervertebral disc disorder, unspecifiedM53 Other dorsopathies, not elsewhere classifiedM530 Cervicocranial syndromeM531 Cervicobrachial syndromeM532 Spinal instabilitiesM533 Sacrococcygeal disorders, not elsewhere classified

M538 Other specified dorsopathiesM539 Dorsopathy, unspecifiedM54 DorsalgiaM540 Panniculitis affecting regions of neck and backM541 RadiculopathyM542 CervicalgiaM543 SciaticaM544 Lumbago with sciaticaM545 Low back painM546 Pain in thoracic spineM548 Other dorsalgiaM549 Dorsalgia, unspecifiedM60 MyositisM600 Infective myositisM601 Interstitial myositisM602 Foreign body granuloma of soft tissue NECM608 Other myositisM609 Myositis, unspecifiedM61 Calcification and ossification of muscleM610 Myositis ossificans traumaticaM611 Myositis ossificans progressivaM612 Paralytic calcification and ossification of muscleM613 Calcification and ossification of muscles assoc with burnsM614 Other calcification of muscleM615 Other ossification of muscleM619 Calcification and ossification of muscle, unspecifiedM62 Other disorders of muscleM620 Diastasis of muscleM621 Other rupture of muscle (nontraumatic)M622 Ischaemic infarction of muscleM623 Immobility syndrome (paraplegic)M624 Contracture of muscleM625 Muscle wasting and atrophy, not elsewhere classifiedM626 Muscle strainM628 Other specified disorders of muscleM629 Disorder of muscle, unspecifiedM63 Disorders of muscle in diseases classified elsewhereM630 A Myositis in bacterial diseases classified elsewhereM631 A Myositis in protozoal and parasitic infections ECM632 A Myositis in other infectious diseases classified elsewhereM633 A Myositis in sarcoidosisM638 A Other disorders of muscle in diseases classified elsewhereM65 Synovitis and tenosynovitisM650 Abscess of tendon sheathM651 Other infective (teno)synovitisM652 Calcific tendinitisM653 Trigger fingerM654 Radial styloid tenosynovitis [de Quervain]M658 Other synovitis and tenosynovitisM659 Synovitis and tenosynovitis, unspecifiedM66 Spontaneous rupture of synovium and tendonM660 Rupture of popliteal cystM661 Rupture of synoviumM662 Spontaneous rupture of extensor tendonsM663 Spontaneous rupture of flexor tendonsM664 Spontaneous rupture of other tendons

M665 Spontaneous rupture of unspecified tendonM67 Other disorders of synovium and tendonM670 Short Achilles tendon (acquired)M671 Other contracture of tendon (sheath)M672 Synovial hypertrophy, not elsewhere classifiedM673 Transient synovitisM674 GanglionM678 Other specified disorders of synovium and tendonM679 Disorder of synovium and tendon, unspecifiedM68 Disorder of synovium and tendon in dis classif elsewhereM680 A Synovitis and tenosynovitis in bacterial diseases ECM688 A Other disorders of synovium and tendon in diseases EC+M70 Soft tissue disorders related to use, overuse and pressureM700 Chronic crepitant synovitis of hand and wristM701 Bursitis of handM702 Olecranon bursitisM703 Other bursitis of elbowM704 Prepatellar bursitisM705 Other bursitis of kneeM706 Trochanteric bursitisM707 Other bursitis of hipM708 Oth soft tiss disorder related to use overuse and pressureM709 Unsp soft tis disorder related to use overuse and pressureM71 Other bursopathiesM710 Abscess of bursaM711 Other infective bursitisM712 Synovial cyst of popliteal space [Baker]M713 Other bursal cystM714 Calcium deposit in bursaM715 Other bursitis, not elsewhere classifiedM718 Other specified bursopathiesM719 Bursopathy, unspecifiedM72 Fibroblastic disordersM720 Palmar fascial fibromatosis [Dupuytren]M721 Knuckle padsM722 Plantar fascial fibromatosisM723 Nodular fasciitisM724 Pseudosarcomatous fibromatosisM725 Fasciitis, not elsewhere classifiedM728 Other fibroblastic disordersM729 Fibroblastic disorder, unspecifiedM73 Soft tissue disorders in diseases classified elsewhereM730 A Gonococcal bursitisM731 A Syphilitic bursitisM738 A Other soft tissue disorders in diseases classified elsewhereM75 Shoulder lesionsM750 Adhesive capsulitis of shoulderM751 Rotator cuff syndromeM752 Bicipital tendinitisM753 Calcific tendinitis of shoulderM754 Impingement syndrome of shoulderM755 Bursitis of shoulderM758 Other shoulder lesionsM759 Shoulder lesion, unspecifiedM76 Enthesopathies of lower limb, excluding footM760 Gluteal tendinitis

M761 Psoas tendinitisM762 Iliac crest spurM763 Iliotibial band syndromeM764 Tibial collateral bursitis [Pellegrini-Stieda]M765 Patellar tendinitisM766 Achilles tendinitisM767 Peroneal tendinitisM768 Other enthesopathies of lower limb, excluding footM769 Enthesopathy of lower limb, unspecifiedM77 Other enthesopathiesM770 Medial epicondylitisM771 Lateral epicondylitisM772 Periarthritis of wristM773 Calcaneal spurM774 MetatarsalgiaM775 Other enthesopathy of footM778 Other enthesopathies, not elsewhere classifiedM779 Enthesopathy, unspecifiedM79 Other soft tissue disorders, not elsewhere classifiedM790 Rheumatism, unspecifiedM791 MyalgiaM792 Neuralgia and neuritis, unspecifiedM793 Panniculitis, unspecifiedM794 Hypertrophy of (infrapatellar) fat padM795 Residual foreign body in soft tissueM796 Pain in limbM798 Other specified soft tissue disordersM799 Soft tissue disorder, unspecifiedM80 Osteoporosis with pathological fractureM800 Postmenopausal osteoporosis with pathological fractureM801 Postoophorectomy osteoporosis with pathological fractureM802 Osteoporosis of disuse with pathological fractureM803 Postsurgical malabsorption osteoporosis with path fractureM804 Drug-induced osteoporosis with pathological fractureM805 Idiopathic osteoporosis with pathological fractureM808 Other osteoporosis with pathological fractureM809 Unspecified osteoporosis with pathological fractureM81 Osteoporosis without pathological fractureM810 Postmenopausal osteoporosisM811 Postoophorectomy osteoporosisM812 Osteoporosis of disuseM813 Postsurgical malabsorption osteoporosisM814 Drug-induced osteoporosisM815 Idiopathic osteoporosisM816 Localized osteoporosis [Lequesne]M818 Other osteoporosisM819 Osteoporosis, unspecifiedM82 Osteoporosis in diseases classified elsewhereM820 A Osteoporosis in multiple myelomatosisM821 A Osteoporosis in endocrine disordersM828 A Osteoporosis in other diseases classified elsewhereM83 Adult osteomalaciaM830 Puerperal osteomalaciaM831 Senile osteomalaciaM832 Adult osteomalacia due to malabsorptionM833 Adult osteomalacia due to malnutrition

M834 Aluminium bone diseaseM835 Other drug-induced osteomalacia in adultsM838 Other adult osteomalaciaM839 Adult osteomalacia, unspecifiedM84 Disorders of continuity of boneM840 Malunion of fractureM841 Nonunion of fracture [pseudarthrosis]M842 Delayed union of fractureM843 Stress fracture, not elsewhere classifiedM844 Pathological fracture, not elsewhere classifiedM848 Other disorders of continuity of boneM849 Disorder of continuity of bone, unspecifiedM85 Other disorders of bone density and structureM850 Fibrous dysplasia (monostotic)M851 Skeletal fluorosisM852 Hyperostosis of skullM853 Osteitis condensansM854 Solitary bone cystM855 Aneurysmal bone cystM856 Other cyst of boneM858 Other specified disorders of bone density and structureM859 Disorder of bone density and structure, unspecifiedM86 OsteomyelitisM860 Acute haematogenous osteomyelitisM861 Other acute osteomyelitisM862 Subacute osteomyelitisM863 Chronic multifocal osteomyelitisM864 Chronic osteomyelitis with draining sinusM865 Other chronic haematogenous osteomyelitisM866 Other chronic osteomyelitisM868 Other osteomyelitisM869 Osteomyelitis, unspecifiedM87 OsteonecrosisM870 Idiopathic aseptic necrosis of boneM871 Osteonecrosis due to drugsM872 Osteonecrosis due to previous traumaM873 Other secondary osteonecrosisM878 Other osteonecrosisM879 Osteonecrosis, unspecifiedM88 Paget's disease of bone [osteitis deformans]M880 Paget's disease of skullM888 Paget's disease of other bonesM889 Paget's disease of bone, unspecifiedM89 Other disorders of boneM890 AlgoneurodystrophyM891 Epiphyseal arrestM892 Other disorders of bone development and growthM893 Hypertrophy of boneM894 Other hypertrophic osteoarthropathyM895 OsteolysisM896 Osteopathy after poliomyelitisM898 Other specified disorders of boneM899 Disorder of bone, unspecifiedM90 Osteopathies in diseases classified elsewhereM900 A Tuberculosis of boneM901 A Periostitis in other infectious diseases EC

M902 A Osteopathy in other infectious diseases classified elsewhereM903 A Osteonecrosis in caisson diseaseM904 A Osteonecrosis due to haemoglobinopathyM905 A Osteonecrosis in other diseases classified elsewhereM906 A Osteitis deformans in neopastic diseaseM907 A Fracture of bone in neopastic diseaseM908 A Osteopathy in other diseases classified elsewhereM91 Juvenile osteochondrosis of hip and pelvisM910 Juvenile osteochondrosis of pelvisM911 Juv osteochondrosis head of femur [Legg-Calv_-Perthes]M912 Coxa planaM913 PseudocoxalgiaM918 Other juvenile osteochondrosis of hip and pelvisM919 Juvenile osteochondrosis of hip and pelvis, unspecifiedM92 Other juvenile osteochondrosisM920 Juvenile osteochondrosis of humerusM921 Juvenile osteochondrosis of radius and ulnaM922 Juvenile osteochondrosis of handM923 Other juvenile osteochondrosis of upper limbM924 Juvenile osteochondrosis of patellaM925 Juvenile osteochondrosis of tibia and fibulaM926 Juvenile osteochondrosis of tarsusM927 Juvenile osteochondrosis of metatarsusM928 Other specified juvenile osteochondrosisM929 Juvenile osteochondrosis, unspecifiedM93 Other osteochondropathiesM930 Slipped upper femoral epiphysis (nontraumatic)M931 Kienbock's disease of adultsM932 Osteochondritis dissecansM938 Other specified osteochondropathiesM939 Osteochondropathy, unspecifiedM94 Other disorders of cartilageM940 Chondrocostal junction syndrome [Tietze]M941 Relapsing polychondritisM942 ChondromalaciaM943 ChondrolysisM948 Other specified disorders of cartilageM949 Disorder of cartilage, unspecifiedM95 Oth acq deformities musculoskel sys and connective tisM950 Acquired deformity of noseM951 Cauliflower earM952 Other acquired deformity of headM953 Acquired deformity of neckM954 Acquired deformity of chest and ribM955 Acquired deformity of pelvisM958 Other specified acquired deformities of musculoskel sysM959 Acquired deformity of musculoskeletal system, unspecifiedM96 Postprocedural musculoskeletal disorders NECM960 Pseudarthrosis after fusion or arthrodesisM961 Postlaminectomy syndrome, not elsewhere classifiedM962 Postradiation kyphosisM963 Postlaminectomy kyphosisM964 Postsurgical lordosisM965 Postradiation scoliosisM966 Fract bone fllg ins orthopae implt jnt prosthesis/bone plateM968 Other postprocedural musculoskeletal disorders

M969 Postprocedural musculoskeletal disorder, unspecifiedM99 Biomechanical lesions, not elsewhere classifiedM990 Segmental and somatic dysfunctionM991 Subluxation complex (vertebral)M992 Subluxation stenosis of neural canalM993 Osseous stenosis of neural canalM994 Connective tissue stenosis of neural canalM995 Intervertebral disc stenosis of neural canalM996 Osseous and subluxation stenosis of intervertebral foraminaM997 Connective tis and disc stenosis of intervertebral foraminaM998 Other biomechanical lesionsM999 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 pectorisI200 Unstable anginaI201 Angina pectoris with documented spasmI208 Other forms of angina pectorisI209 Angina pectoris, unspecifiedI21 Acute myocardial infarctionI210 Acute transmural myocardial infarction of anterior wallI211 Acute transmural myocardial infarction of inferior wallI212 Acute transmural myocardial infarction of other sitesI213 Acute transmural myocardial infarction of unspecified siteI214 Acute subendocardial myocardial infarctionI219 Acute myocardial infarction, unspecifiedI22 Subsequent myocardial infarctionI220 Subsequent myocardial infarction of anterior wallI221 Subsequent myocardial infarction of inferior wallI228 Subsequent myocardial infarction of other sitesI229 Subsequent myocardial infarction of unspecified siteI23 Certain current complication follow acute myocardial infarctI230 Haemopericardium as curr comp folow acut myocard infarctI231 Atral sept defect as curr comp folow acut myocardal infarctI232 Ventric sep defect as curr comp fol acut myocardal infarcI233 Rup cardac wal withou haemopercard as cur comp fol ac MII234 Rup chordae tendinae as curr comp fol acut myocard infarctI235 Rup papilary muscle as curr comp fol acute myocard infarct

I236 Thromb atrium/auric append/vent as curr comp foll acute MII238 Oth current comp following acute myocardial infarctionI24 Other acute ischaemic heart diseasesI240 Coronary thrombosis not resulting in myocardial infarctionI241 Dressler's syndromeI248 Other forms of acute ischaemic heart diseaseI249 Acute ischaemic heart disease, unspecifiedI25 Chronic ischaemic heart diseaseI250 Atherosclerotic cardiovascular disease, so describedI251 Atherosclerotic heart diseaseI252 Old myocardial infarctionI253 Aneurysm of heartI254 Coronary artery aneurysmI255 Ischaemic cardiomyopathyI256 Silent myocardial ischaemiaI258 Other forms of chronic ischaemic heart diseaseI259 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 failureI500 Congestive heart failureI501 Left ventricular failureI509 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 CardiologistHeart of England NHS Foundation Trust the findings were presented at the Circulatory ForumThe 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

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 ccC07 Minor Medical Head, Neck or Ear Diagnoses <70 w/o ccH22 Minor Procedures to the Musculoskeletal SystemH41 Sprains, Strains, or Minor Open Wounds >69 or w ccH42 Sprains, Strains, or Minor Open Wounds <70 w/o ccH63 Head Injury >69 or w ccH64 Head Injury <70 w/o ccJ36 Minor Skin Procedures - Category 1 w ccJ37 Minor Skin Procedures - Category 1 w/o ccJ43 Major Skin TumoursJ44 Minor Dermatological Conditions or Benign TumoursJ45 Minor Skin InfectionsL20 Bladder Minor Endoscopic Procedure w ccL21 Bladder Minor Endoscopic Procedure w/o ccL22 Bladder or Urinary Mechanical Problems >69 or w ccL23 Bladder or Urinary Mechanical Problems <70 w/o ccL30 Prostate or Bladder Neck Minor Endoscopic Procedure (Male and Female)L41 Vasectomy ProceduresL45 Extracorporeal LithotripsyM09 Threatened or Spontaneous AbortionS34 Other Procedures and Health Care Problems

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