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Spirometry codes for COPD (Must be done between three months before and up to twelve months after diagnosis)

745D4 Post bronchodilator spirometry
8HRC. Referral for spirometry

Spirometry exception codes (Added in the last 12 months)

8I3b. Spirometry test declined
8I6L. Spirometry not indicated
8I2j. Spirometry contraindicated
33720 Unable to perform spirometry


COPD Codes

H3... Chronic obstructive pulmonary disease
H31.. Chronic bronchitis
H310. Simple chronic bronchitis
H3100 Chronic catarrhal bronchitis
H310z Simple chronic bronchitis NOS
H311. Mucopurulent chronic bronchitis
H3110 Purulent chronic bronchitis
H3111 Fetid chronic bronchitis
H311z Mucopurulent chronic bronchitis NOS
H312. Obstructive chronic bronchitis
H3120 Chronic asthmatic bronchitis
H3121 Emphysematous bronchitis
H3123 Bronchiolitis obliterans
H312z Obstructive chronic bronchitis NOS
H313. Mixed simple and mucopurulent chronic bronchitis
H31y. Other chronic bronchitis
H31y1 Chronic tracheobronchitis
H31yz Other chronic bronchitis NOS
H31z. Chronic bronchitis NOS
H32.. Emphysema
H320. Chronic bullous emphysema
H3200 Segmental bullous emphysema
H3201 Zonal bullous emphysema
H3202 Giant bullous emphysema
H3203 Bullous emphysema with collapse
H320z Chronic bullous emphysema NOS
H321. Panlobular emphysema
H322. Centrilobular emphysema
H32y. Other emphysema
H32y0 Acute vesicular emphysema
H32y1 Atrophic (senile) emphysema
H32y2 MacLeod's unilateral emphysema
H32yz Other emphysema NOS
H32z. Emphysema NOS
H36.. Mild chronic obstructive pulmonary disease
H37.. Moderate chronic obstructive pulmonary disease
H38.. Severe chronic obstructive pulmonary disease
H39.. Very severe chronic obstructive pulmonary disease
H3A.. End stage chronic obstructive airways disease
H3y.. Other specified chronic obstructive airways disease
H3y0. Chronic obstructive pulmonary disease with acute lower respiratory infection
H3y1. Chronic obstructive pulmonary disease with acute exacerbation, unspecified
H3z.. Chronic obstructive airways disease NOS
H5832 Eosinophilic bronchitis(v26)

Exclusion codes (Every 12 months)

9h5.. Exception reporting: COPD quality indicators
9h51. Excepted from COPD quality indicators: Patient unsuitable
9h52. Excepted from COPD quality indicators: Informed dissent

COPD 002.1 Rationale

A diagnosis of COPD relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry.

NICE clinical guidelines provide the following definition of COPD:

The NICE guidelines require post bronchodilator spirometry for diagnosis and gradation of severity of airways obstruction. Failure to use post bronchodilator readings has been shown to overestimate the prevalence of COPD by 25 per cent45. Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g. 400mcg salbutamol).

Prior to performing post-bronchodilator spirometry, patients do not need to stop any therapy, such as long acting bronchodilators or inhaled steroids.

Routine reversibility testing is not recommended. However, where doubt exists as to whether the diagnosis is asthma or COPD, reversibility testing may add additional information to post bronchodilator readings alone and peak flow charts are useful. It is acknowledged that COPD and asthma can co-exist and that many patients with asthma who smoke will eventually develop irreversible airways obstruction. Where asthma is present, these patients should be managed as asthma patients as well as COPD patients. This will be evidenced by a greater than 400mls response to a reversibility test and a post bronchodilator FEV1 of less than 80 per cent of predicted normal as well as an appropriate medical history.

Patients with reversible airways obstruction should be included on the asthma register. Patients with coexisting asthma and COPD should be included on the register for both conditions.

The guideline on COPD recommends that all health professionals involved in the care of patients with COPD should have access to spirometry and be competent in the interpretation of the results. Quality statement 1 (diagnosis) in the NICE quality standard for COPD in adults states that patients with COPD have the diagnosis confirmed by post bronchodilator spirometry carried out on calibrated equipment by healthcare professionals competent in its performance and interpretation.

Further information
NICE clinical guideline 101 (2010). Chronic obstructive pulmonary disease.

NICE quality standard on COPD (2011). Chronic obstructive pulmonary disease (COPD) quality standard.

From April 2011 the diagnostic codes for this indicator have been updated to include new codes for post bronchodilator spirometry. The previous codes for reversibility testing will no longer be acceptable for QOF purposes.

COPD 002.2 Reporting and verification

See indicator wording for requirement criteria.

Prepared By Jean Keenan