• Spirometry Exception codes - go to this
• COPD Exclusion codes - go to this
• COPD codes go to this
• COPD Rationale - go to this

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:

• airflow obstruction is defined as a reduced FEV1/FVC ratio (where FEV1 is forced expired volume in one second and FVC is forced vital capacity), such that FEV1/FVC is less than 0.7
• if FEV1 is greater than or equal to 80 per cent predicted normal a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough.

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.
http://guidance.nice.org.uk/CG101/NICEGuidance/pdf/English

NICE quality standard on COPD (2011). Chronic obstructive pulmonary disease (COPD) quality standard.
http://www.nice.org.uk/guidance/qualitystandards/chronicobstructivepulmonarydisease/copdqualitystandard.jsp

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