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Diagnosed with Stroke or the first TIA after 1/4/2014

MRI / CT scan codes ( 3 months before diagnosis or up to 1 month after)

567.. Computerised axial tomography
5671. CAT scan requested
5672. CAT scan normal
5673. CAT scan abnormal
569.. Nuclear magnetic resonance
5691. Nuclear magn.reson.requested
5692. Nuclear magn reson normal
5693. Nuclear magn.reson. abnormal
5675. CAT scan - brain
567C. CAT scan brain - abnormal
5694. Magnetic resonance imaging of brain abnormal
569F. Magnetic resonance imaging of brain normal
5C00. CT scan brain - normal
5C12. Computerised tomography brain scan abnormal(v14)
8HQ3. Refer for NMR scanning
8HQ4. Refer for CAT scanning
8HBJ. Stroke / transient ischaemic attack referral
8HTQ. Referral to stroke clinic
569K0 Magnetic resonance imaging of brain (v18)

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Codes for MRI / CT declined (within 12 months of diagnosis date)

5695. Magnetic resonance imaging scan declined
56F0. CT scan brain declined

Stroke exception reporting codes (within last 12 months)

9h2.. Exception reporting: stroke quality indicators
9h21. Excepted from stroke quality indicators: Patient unsuitable
9h22. Excepted from stroke quality indicators: Informed dissent
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Stroke codes

G61.. Intracerebral haemorrhage
G610. Cortical haemorrhage
G611. Internal capsule haemorrhage
G612. Basal nucleus haemorrhage
G613. Cerebellar haemorrhage
G614. Pontine haemorrhage
G615. Bulbar haemorrhage
G616. External capsule haemorrhage
G618. Intracerebral haemorrhage, multiple localized
G619. Lobar cerebral haemorrhage
G61X. Intracerebral haemorrhage in hemisphere, unspecified
G61X0 Left sided intracerebral haemorrhage, unspecified
G61X1 Right sided intracerebral haemorrhage, unspecified
G61z. Intracerebral haemorrhage NOS
G63y0 Cerebral infarct due to thrombosis of precerebral arteries
G63y1 Cerebral infarction due to embolism of precerebral arteries

 

G64.. Cerebral arterial occlusion
G640. Cerebral thrombosis
G6400 Cerebral infarction due to thrombosis of cerebral arteries
G641. Cerebral embolism
G6410 Cerebral infarction due to embolism of cerebral arteries
G64z. Cerebral infarction NOS
G64z0 Brainstem infarction
G64z1 Wallenberg syndrome
G64z2 Left sided cerebral infarction
G64z3 Right sided cerebral infarction
G64z4 Infarction of basal ganglia

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G66.. Stroke and cerebrovascular accident unspecified
G660. Middle cerebral artery syndrome
G661. Anterior cerebral artery syndrome
G662. Posterior cerebral artery syndrome
G663. Brain stem stroke syndrome
G664. Cerebellar stroke syndrome
G665. Pure motor lacunar syndrome
G666. Pure sensory lacunar syndrome
G667. Left sided CVA
G668. Right sided CVA
G6760 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
G6W.. Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries
G6X.. Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries
Gyu62 [X]Other intracerebral haemorrhage (v26)
Gyu63 [X]Cerebrl infarctn due/unspci occlusn or sten/cerebrl artrs
Gyu64 [X]Other cerebral infarction
Gyu65 [X]Occlusion and stenosis of other precerebral arteries
Gyu66 [X]Occlusion and stenosis of other cerebral arteries
Gyu6F [X]Intracerebral haemorrhage in hemisphere, unspecified
Gyu6G [X]Cereb infarct due unsp occlus/stenos precerebr arteries
ZV125 [V]Personal history of circulatory system disease

TIA Codes

G65.. Transient cerebral ischaemia
G650. Basilar artery syndrome
G651. Vertebral artery syndrome
G6510 Vertebro-basilar artery syndrome
G652. Subclavian steal syndrome
G653. Carotid artery syndrome hemispheric
G654. Multiple and bilateral precerebral artery syndromes
G656. Vertebrobasilar insufficiency
G657. Carotid territory transient ischaemic attack
G65y. Other transient cerebral ischaemia
G65z. Transient cerebral ischaemia NOS
G65z0 Impending cerebral ischaemia
G65z1 Intermittent cerebral ischaemia
G65zz Transient cerebral ischaemia NOS
F4236 Amaurosis fugax (v22)
ZV12D [V]Personal history of transient ischaemic attack
Fyu55 [X]Other transient cerebral ischaemic attacks and related syndromes

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STIA 008.1 Rationale

Specialist investigations are often only accessible by a referral to secondary care services, therefore this indicator reflects referral activity rather than confirmation by specific scanning investigations.

Previously this indicator required that practices recorded a referral for further investigation after the last recorded stroke or TIA. From April 2014 this indicator was amended so that practices are only required to record a referral for further investigations following the first TIA or latest stroke for achievement. This is to allow for clinical discretion for referral of subsequent TIAs. However, practices are reminded that current NICE and Royal College of Physician guidelines for stroke recommend that patients with suspected TIA should receive specialist assessment and investigation within a timeframe based on stroke risk. A TIA is an opportunity to prevent a stroke and therefore good practice is to refer people in line with current national clinical guidelines.

The National Audit Office (NAO) Report highlights that UK national guidelines recommend that all patients with suspected TIA should be assessed and investigated within seven days, but notes that only a third of patients with TIA are seen in a clinic. The UK Guideline and the NAO concern reflect the evidence that there is a high early risk of stroke following TIA, and that there is insufficient recognition of the serious nature of this diagnosis.

Contractors are advised that a referral should be considered for each new stroke or TIA unless specific agreement has been reached with a local specialist not to refer the patients.

STIA 008.2 Reporting and verification

See indicator wording for requirement criteria.

For the purpose of this indicator, the business rules will be looking for the latest recording of stroke or the first recorded TIA and then whether or not the referral occurred between three months before or one month after either of these dates.

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Prepared By Jean Keenan