QOF

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Patients will be on the mental health register if they have one of the following:

Psychosis, schizophrenia and bipolar affective disease codes (the earliest code)

E10..% Schizophrenic disorders
E110.% Manic disorder, single episode
E111.% Recurrent manic episodes
E1124 Single major depressive episode, severe, with psychosis
E1134 Recurrent major depressive episode, severe, with psychosis
E114% Bipolar affective disorder, currently manic
E115% Bipolar affective disorder, currently depressed
E116% Mixed bipolar affective disorder
E117% Unspecified bipolar affective disorder
E11y.% Other and unspecified manic-depressive psychoses (excluding E11y2 Atypical depressive disorder)
E11z. Other and unspecified affective psychoses
E11z0 Unspecified affective psychoses NOS
E11zz Other affective psychosis NOS
E12..% Paranoid states
E13..% Other nonorganic psychoses (excluding E135.. Agitated depression)

E2122 Schizotypal personality
Eu2..% [X]Schizophrenia, schizotypal and delusional disorders
 
Eu30. [X]Manic episode
Eu300 [X]Hypomania
Eu301 [X]Mania without psychotic symptoms
Eu302 [X]Mania with psychotic symptoms
Eu30y [X]Other manic episodes
Eu30z [X]Manic episode, unspecified
Eu31. [X]Bipolar affective disorder
Eu310 [X]Bipolar affective disorder, current episode hypomanic
Eu311 [X]Bipolar affective disorder, current episode manic without psychotic symptoms
Eu312 [X]Bipolar affective disorder, current episode manic with psychotic symptoms
Eu313 [X]Bipolar affective disorder, current episode mild or moderate depression
Eu314 [X]Bipolar affective disorder, current episode severe depression without psychotic symptoms
Eu315 [X]Bipolar affective disorder, current episode severe depression with psychotic symptoms
Eu316 [X]Bipolar affective disorder, current episode mixed
Eu317 [X]Bipolar affective disorder, currently in remission
Eu318 [X]Bipolar affective disorder type I
Eu319 [X]Bipolar affective disorder type II

Eu31y [X]Other bipolar affective disorders
Eu31z [X]Bipolar affective disorder, unspecified
Eu323 [X]Severe depressive episode with psychotic symptoms
Eu328 [X]Major depression, severe with psychotic symptoms (v16)
Eu329 [X]Single major depressive episode, severe, with psychosis, psychosis in remission
Eu32A [X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission
Eu333 [X]Recurrent depressive disorder, current episode severe with psychotic symptoms

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Or

Code for Lithium prescription

d6...%

Without Code for ‘Stopped lithium’

665B. Lithium stopped

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Mental Health exception reporting codes(Added in the last 12 months)

9h9.. Exception reporting: mental health quality indicators
9h91. Excepted from mental health quality indicators: Patient unsuitable
9h92. Excepted from mental health quality indicators: Informed dissent

 

MH 001.1: Rationale

The register includes all patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy.

Remission from serious mental illness
Historically, patients have been added to the QOF mental health register for schizophrenia, bipolar affective disorder and other psychoses but over time it has become apparent that it may be appropriate to exclude some of them from the associated indicators because their illness is in remission.

Making an accurate diagnosis of remission for a patient with a diagnosis of serious mental illness can be challenging and the evidence base to support when to use the 'remission code' is largely based on clinical judgment. A recent longitudinal international study of recovery from psychotic illnesses found that as many as 56 per cent of patients recovered from psychotic illnesses to some extent, although only 16 per cent recover if a more stringent concept of recovery is used.

In the absence of strong evidence of what constitutes 'remission' from serious mental illness, clinicians should only consider using the remission codes if the person has been in remission for at least five years, that is:

Where a patient is recorded as being ‘in remission’ they remain on the register (in case their condition relapses at a later date) but they are excluded from the denominator for mental health indicators MH002, MH003, MH007 and MH008.

The accuracy of this diagnosis and the coding should be reviewed on an annual basis by a GP. If a patient who has been coded as ‘in remission’ experience a relapse then this should be recorded as such in their patient record.

In the event that a patient experiences a relapse and is coded as such, they will once again be included in all the associated indicators for schizophrenia, bipolar affective disorder and other psychoses.

MH 001.2: Reporting and verification

See indicator wording for requirement criteria.

The register includes patients with a current condition and also those recorded as being in remission, however patients recorded as 'in remission' will be excluded from mental health indicators MH002, MH003, MH007 and MH008.

Verification – NHS England may require randomly selecting a number of patient records of patients in which a ‘remission code’ has been recorded and request evidence as to why it was appropriate for that patient to be considered ‘in remission’.

Contractors may be expected to demonstrate they have a protocol to guide their clinicians as to how this would work and who would be suitable to make the decision. It would not be appropriate for non-clinical members of the practice to make the decision as to when to enter this code.

The NHS England may require contractors to demonstrate that patients coded as being in remission have received no anti-psychotic medications, mental health in-patient admissions, or mental health secondary or community care for at least five years prior to the entry of the remission code in their record.

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Prepared By Jean Keenan