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Codes for MRC Breathlessness Scale Score >=3 (Added in last 12 months)

173J. MRC Breathlessness Scale: grade 3
173K. MRC Breathlessness Scale: grade 4
173L. MRC Breathlessness Scale: grade 5

Codes for oxygen saturation value (Added in last 12 months)

44YA0 Oxygen saturation at periphery
44YA1 Peripheral blood oxygen saturation on room air at rest
44YA3 Peripheral blood oxygen saturation on supplemental oxygen at rest
44YA5 Baseline SpO2 (oxygen saturation at periphery) (v30)

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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 005.1 Rationale

As COPD progresses, patients often become hypoxaemic. Many patients tolerate mild hypoxaemia well, but once the resting partial pressure of oxygen in arterial blood (PaO2) falls below 8 KPa patients begin to develop signs of right-sided HF (cor pulmonale), principally peripheral oedema. The prognosis is poor and if untreated the five year survival is less than 50 per cent.

In stable COPD, patients use oxygen therapy for long periods during the day and night. Long-term oxygen therapy can improve survival in patients with COPD who have severe hypoxaemia, where PaO2 is less than 8 KPa. It can also reduce the incidence of polycythaemia (that is, raised red cell count), reducing the progression of pulmonary hypertension and improving psychological wellbeing.

NICE clinical guideline CG101 recommends that patients with oxygen saturations of 92 per cent or lower when breathing air, be considered for oxygen therapy. Pulse oximetry (SpO2) provides an estimate of arterial oxygen saturation (SaO2) and is non-invasive.

Pulse oximetry allows practitioners to assess patientsí level of oxygen saturation to determine if whether referral for clinical assessment and long-term oxygen therapy is appropriate. Pulse oximetry is a valuable screening tool for identifying patients who are appropriate for referral for long-term oxygen therapy. A normal pulse oximetry reading (SpO2 greater than 92 per cent) can reliably identify patients who do not need referral. However, pulse oximetry cannot predict which patients with an abnormal reading (SpO2 of 92 per cent or lower) have sufficiently severe hypoxaemia to require long-term oxygen therapy, therefore these patients require further assessment.

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COPD 005.2 Reporting and verification

See indicator wording for requirement criteria.

The Business Rules require that a record that pulse oximetry has been performed AND the resulting oxygen saturation value are recorded to meet the requirements for this indicator.

Prepared By Jean Keenan