QOF

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Codes for FEV1 (Added in last 12 months)

33971 Forced expired volume in 1 second percentage change
3398. FEV1/FVC ratio normal
3399. FEV1/FVC ratio abnormal
339M. FEV1/FVC ratio
339O. Forced expired volume in 1 second
339O0 Forced expired volume in 1 second reversibility
339R. FEV1/FVC percent
339S. Percent predicted FEV1
339T. FEV1/FVC > 70% of predicted
339U. FEV1/FVC < 70% of predicted
339a. FEV1 before bronchodilation
339b. FEV1 after bronchodilation
339e. FEV1 pre steroids
339f. FEV1 post steroids
339j. FEV1/FVC ratio pre steroids
339k. FEV1/FVC ratio post steroids
339l. FEV1/FVC ratio before bronchodilator
339m. FEV1/FVC ratio after bronchodilator
339O1 Forced expired volume in one second/vital capacity ratio
33972 FEV1 after change of bronchodilator (v26)

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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

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COPD 004.1 Rationale

There is a gradual deterioration in lung function in patients with COPD. This deterioration accelerates with the passage of time. There are important interventions which can improve quality of life in patients with severe COPD. It is therefore important to monitor respiratory function in order to identify patients who might benefit from pulmonary rehabilitation or continuous oxygen therapy.

NICE clinical guideline 101 recommends that FEV1 and inhaler technique should be assessed at least annually for people with mild/moderate/severe COPD (and in fact at least twice a year for people with very severe COPD). The purpose of regular monitoring is to identify patients with increasing severity of disease who may benefit from referral for more intensive treatments/diagnostic review.

Further information
NICE clinical guideline 101 (2010). Chronic obstructive pulmonary disease. See table six.
http://guidance.nice.org.uk/CG101/NICEGuidance/pdf/English

Contractors should identify those patients who could benefit from long term oxygen therapy and pulmonary rehabilitation.

These measures require specialist referral because of the need to measure arterial oxygen saturation to assess suitability for oxygen therapy, and the advisability of specialist review of patients prior to starting pulmonary rehabilitation.

The long term administration of oxygen (more than 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival and improve exercise capacity.

Referral for consideration for long term oxygen therapy and/or pulmonary rehabilitation should be made to those with appropriate training and expertise. This may include a respiratory physician, a general physician or a GP with a special interest (GPwSI) in respiratory disease. The specific clinical criteria for referral for long term oxygen therapy and pulmonary rehabilitation are set out in NICE clinical guideline CG101.

COPD 004.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan