Estimated activity

— 47,605 episodes during 2018/19

— Age/sex std rate per 100,000 – 80.1

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated

— CCG Variation (age/sex std rates):

— N-fold – 1.5

— 10th percentile – 64.1

— 25th percentile – 72.5

— 50th percentile – 80.3

— 90th percentile – 97.1

Codes

Procedure codes

H01 Emergency excision of appendix

H02 Other excision of appendix

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Patients of all ages

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Dominant procedure code is:

H01 OR

H02

SQL code

Der.spell _ dominant _ procedure like ‘%H0[12]%’
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

This coding is relevant to appropriate colonoscopy in the management of hereditary colorectal cancer and repeat colonoscopy.

Estimated activity

• 415,262 episodes during 2018/19
• Age/sex std rate per 100,000 – 699.0
• Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.
• Variation (age/sex std rates):
  • N-fold – 1.6
  • 10th percentile – 543.6
  • 25th percentile – 612.4
  • 50th percentile – 698.1
  • 90th percentile – 850.1

Codes

Procedure codes

H22.1 Diagnostic fibreoptic endoscopic examination of colon and biopsy of lesion of colon

H22.8 Other specified diagnostic endoscopic examination of colon

H22.9 Unspecified diagnostic endoscopic examination of colon

H68.2 Diagnostic endoscopic examination of colonic pouch using colonoscope NEC

H68.4 Diagnostic endoscopic examination of ileoanal pouch using colonoscope NEC

H68.8 Other specified diagnostic endoscopic examination of enteric pouch using colonoscope

H68.9 Unspecified diagnostic endoscopic examination of enteric pouch using colonoscope

Exclusions:

H68.1 Diagnostic endoscopic examination of colonic pouch and biopsy of colonic pouch using colonoscope

H68.3 Diagnostic endoscopic examination of ileoanal pouch and biopsy of ileoanal pouch using colonoscope

Diagnosis codes

Exclusions:

Z12.1 Encounter for screening for malignant neoplasm of intestinal tract

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

[APC extract only]

Will the procedure be carried out in OP or as APC?

Outpatient and Admitted Patient Care

Coding logic

APC:

Where procedure code in any position is:

H22.1 OR

H22.8 OR

H22.9 OR

H68.2 OR

H68.4 OR

H68.8 OR

H68.9

AND

Procedure code in any position is not:

H68.1 OR

H68.3

AND

Diagnosis code in any position is not:

Z121

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

OPA:

Where procedure code in any position is:

H22.1 OR

H22.8 OR

H22.9 OR

H68.2 OR

H68.4 OR

H68.8 OR

H68.9

AND

Procedure code in any position is not:

H68.1 OR

H68.3

AND

Diagnosis code in any position is not:

Z121

AND

Patient age >=19 years

SQL code

APC extract
(apcs.Der _ Procedure _ All like '%H22[189]%'
Or apcs.Der _ Procedure _ All like '%H68%')
and apcs.der _ diagnosis _ all not like '%Z121%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
AND APCS.Der _ Procedure _ All NOT like '%H68[13]%'
and APCS.Admission _ Method not like ('2%')

OPA extract
(opa.Der _ Procedure _ All like '%H22[189]%'
Or opa.Der _ Procedure _ All like '%H68%')
and ISNULL(opa.der _ diagnosis _ all,'') not like '%Z121%'
and ISNULL(opa.Age _ at _ Start _ of _ Episode _ SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
AND opa.Der _ Procedure _ All NOT like '%H68[13]%'

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%')
OR opa.Der _ Diagnosis _ All IS NULL)

SQL code

(der.Spell_Dominant_Procedure ='O291' and apcs.der_procedure_all like '%Y767%')
and (der.Spell_Primary_Diagnosis like 'M754%' or der.Spell_Primary_Diagnosis like 'M2551%')

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

— 38,088 episodes during 2018/19

— Age/sex std rate per 100,000 – 64.1

— Reduction opportunity: 8,964 (24%) based on 25^th percentile of activity across CCGs.

— Variation (age/sex std rates):

— N-fold – 2.4

— 10th percentile – 40.8

— 25th percentile – 53.2

— 50th percentile – 66.8

— 90th percentile – 97.5

Codes

Procedure codes

W82.1 Endoscopic total excision of semilunar cartilage

W82.2 Endoscopic resection of semilunar cartilage NEC

W82.3 Endoscopic repair of semilunar cartilage

W82.8 Other specified

W82.9 Unspecified

Diagnosis codes

M23.2 Derangement of meniscus due to old tear or injury

M23.3 Other meniscus derangements

S83.2 Tear of meniscus, current

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Patients of all ages

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Dominant procedure code is:

W82.1 OR

W82.2 OR

W82.3 OR

W82.8 OR

W82.9

AND

Diagnosis code in primary position is:

M23.2 OR

M23.3 OR

S83.2

AND

APCS.Admission_Method not like (‘2%’)

SQL code

left(der.Spell _ Dominant _ Procedure,3)='W82'
and (der.Spell _ Primary _ Diagnosis like '%M23[23]%' or der.Spell _ Primary _ Diagnosis like '%S832%')
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

What are we counting?

No coding is available for the procedure or indications.

SQL code

left(der.Spell_Dominant_Procedure,4) in ('B311’) and apcs.der_diagnosis_all not like '%Z853%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in ('A651','A659’) and der.Spell_Primary_Diagnosis like '%G560%' then

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in
('C121','C122','C124','C191','C198’) and
left(der.Spell_Primary_Diagnosis,4) in ('H001')

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

— 2,056 episodes during 2018/19

— Age/sex std rate per 100,000 – 3.5

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— CCG Variation (age/sex std rates):

— N-fold – 5.3

— 10th percentile – 1.2

— 25th percentile – 2.0

— 50th percentile – 3.3

— 90th percentile – 6.3

Codes

Procedure codes

J18.1 Total cholecystectomy and excision of surrounding tissue

J18.2 Total cholecystectomy and exploration of common bile duct

J18.3 Total cholecystectomy NEC

J18.4 Partial cholecystectomy and exploration of common bile duct

J18.5 Partial cholecystectomy NEC

J18.8 Other specified excision of gall bladder

J18.9 Unspecified excision of gall bladder

Diagnosis codes

K85.1 Biliary acute pancreatitis

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g.  patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Dominant procedure code is:

J18.1 OR

J18.2 OR

J18.3 OR

J18.4 OR

J18.5 OR

J18.8 OR

J18.9

AND

Primary diagnosis code is:

K85.1

AND

The patient age is >= 19 years

SQL code

Der.Spell _ Dominant _ Procedure like '%J18%'
and der.Spell _ primary _ diagnosis like '%K851%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9] [0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

— 43,704 episodes during 2018/19

— Age/sex std rate per 100,000 – 73.6

— Reduction opportunity: 32,143 (74%) based on 25^th percentile of activity across CCGs.

— Variation (age/sex std rates):

— N-fold – 14.1

— 10th percentile – 13.6

— 25th percentile – 20.6

— 50th percentile – 37.3

— 90th percentile – 191.3

Codes

Procedure codes

M45.5 Diagnostic endoscopic examination of bladder using rigid cystoscope

M45.8 Other specified diagnostic endoscopic examination of bladder

M45.9 Unspecified diagnostic endoscopic examination of bladder

Exclusions:

M45.1 Diagnostic endoscopic examination of bladder and biopsy of lesion of bladder NEC

M45.2 Diagnostic endoscopic examination of bladder and biopsy of lesion of prostate NEC

M45.3 Diagnostic endoscopic examination of bladder and biopsy of lesion of bladder using

M45.4 Diagnostic endoscopic examination of bladder and biopsy of lesion of prostate using

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Male

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where procedure code in dominant position is:

M45.5 OR

M45.8 OR

M45.9

AND

Procedure codes in any position are NOT:

M45.1 Diagnostic endoscopic examination of bladder and biopsy of lesion of bladder NEC

M45.2 Diagnostic endoscopic examination of bladder and biopsy of lesion of prostate NEC

M45.3 Diagnostic endoscopic examination of bladder and biopsy of lesion of bladder using rigid cystoscope

M45.4 Diagnostic endoscopic examination of bladder and biopsy of lesion of bladder using rigid cystoscope

AND

Patient gender is male

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

left(der.Spell _ Dominant _ Procedure,3)='M45'
and apcs.sex=1
AND apcs.der _ procedure _ all NOT LIKE '%M45[1-4]%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

— 26,629 episodes during 2018/19

— Age/sex std rate per 100,000 – 44.8

— Reduction opportunity: 9,529 (36%) based on 25^th percentile of activity across CCGs.

— Variation (age/sex std rates):

— N-fold – 3.2

— 10th percentile – 22.0

— 25th percentile – 30.1

— 50th percentile – 41.4

— 90th percentile – 266.3

Codes

Procedure codes

K63.1 Angiocardiography of combination of right and left side of heart

K63.2 Angiocardiography of right side of heart NEC

K63.3 Angiocardiography of left side of heart NEC

K63.4 Coronary arteriography using two catheters

K63.5 Coronary arteriography using single catheter

K63.6 Coronary arteriography NEC

K63.8 Other specified

K63.9 Unspecified

Diagnosis codes

Exclude patients with:

I20.0 – unstable angina

I20.1 – angina pectoris with documented spasm

I21.0 ST elevation (STEMI) myocardial infarction of anterior wall

I21.1 ST elevation (STEMI) myocardial infarction of inferior wall

I21.2 ST elevation (STEMI) myocardial infarction of other sites

I21.3 ST elevation (STEMI) myocardial infarction of unspecified site

I21.4 Non-ST elevation (NSTEMI) myocardial infarction

I21.9 Acute myocardial infarction, unspecified

I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall

I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall

I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction

I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites

I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site

I23.0 Hemopericardium as current complication following acute myocardial infarction

I23.1 Atrial septal defect as current complication following acute myocardial infarction

I23.2 Ventricular septal defect as current complication following acute myocardial infarction

I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction

I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction

I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction

I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction

I23.7 Postinfarction angina

I23.8 Other current complications following acute myocardial infarction

I24.0 Acute coronary thrombosis not resulting in myocardial infarction

I24.1 Dressler’s syndrome

I24.8 Other forms of acute ischemic heart disease

I24.9 Acute ischemic heart disease, unspecified

I25.1 Atherosclerotic heart disease of native coronary artery

I25.2 Old myocardial infarction

I25.3 Aneurysm of heart

I25.4 Coronary artery aneurysm and dissection

I25.5 Ischemic cardiomyopathy

I25.6 Silent myocardial ischemia

I25.7 Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris

I25.8 Other forms of chronic ischemic heart disease

I25.9 Chronic ischemic heart disease, unspecified

 (Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where the procedure code in dominant position is:

K63.1 OR

K63.2 OR

K63.3 OR

K63.4 OR

K63.5 OR

K63.6 OR

K63.8 OR

K63.9

AND

Diagnosis code in any position IS NOT:

I20.0 OR

I20.1 OR

I21.0 OR

I21.1 OR

I21.2 OR

I21.3 OR

I21.4 OR

I21.9 OR

I22.0 OR

I22.1 OR

I22.2 OR

I22.8 OR

I22.9 OR

I23.0 OR

I23.1 OR

I23.2 OR

I23.3 OR

I23.4 OR

I23.5 OR

I23.6 OR

I23.7 OR

I23.8 OR

I24.0 OR

I24.1 OR

I24.8 OR

I24.9 OR

I25.1 OR

I25.2 OR

I25.3 OR

I25.4 OR

I25.5 OR

I25.6 OR

I25.7 OR

I25.8 OR

I25.9

AND

Patient age >=19 years

SQL code

o LEFT(der.Spell _ Dominant _ Procedure,4)like '%K63[12345689]%'
AND (apcs.der _ diagnosis _ all not like '%I20[01]%'
AND apcs.der _ diagnosis _ all not like '%I2[12345]%')
and isnull(APCS.Age _ At _ Start _ of _ Spell_ SUS,APCS.Der _ Age _ at _ CDS _ Activity _Date) between 19 and 120

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

SQL code

left(der.Spell_Dominant_Procedure,4) in ('Q103’) and apcs.der_diagnosis_all not like '%O0[0-8]%' and apcs.der_diagnosis_all not like '%O6[0-9]%' and apcs.der _diagnosis_all not like '%O7[0-5]%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in ('T521','T522','T525','T526','T541','T561')
and Isnull(APCS.Age_At_Start_of_Spell_SUS, Der_Age_at_CDS_Activity_Date) between 19 and 120 and left(der.Spell_Primary_Diagnosis,4)='M720'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

— 308 episodes during 2018/19

— Age/sex std rate per 100,000 – 0.5

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— Variation (age/sex std rates):

— N-fold – 7.2

— 10th percentile – 0.2

— 25th percentile – 0.4

— 50th percentile – 0.6

— 90th percentile – 1.5

Codes

Procedure codes

J43.1 Endoscopic retrograde cholangiopancreatography and biopsy of lesion of ampulla of Vater

J43.2 Endoscopic retrograde cholangiopancreatography and biopsy of lesion of biliary or pancreatic system NEC

J43.3 Endoscopic retrograde cholangiopancreatography and collection of bile

J43.8 Other specified diagnostic endoscopic retrograde examination of bile duct and pancreatic duct

J43.9 Unspecified diagnostic endoscopic retrograde examination of bile duct and pancreatic duct

Diagnosis codes

K85.1 Biliary acute pancreatitis

Any other criteria (e.g. patient age)

The procedure occurs within the first 3 days of admission

Adult >= 19 years

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where the procedure code in any position is:

J43.1 OR

J43.2 OR

J43.3 OR

J43.8 OR

J43.9

AND

Diagnosis code in any position is:

K85.1

AND

The procedure date is 3 days or fewer after the admission

date.

AND

The patient age is >= 19 years

SQL code

isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and apcs.Administrative _ Category<>'02'
and apcs.Discharge _ Date BETWEEN (select min(startdate) from #Datelookup) and (select max(enddate) from #Datelookup)
AND
apcs.[Der _ Procedure _ All] LIKE '%J43[12389]%'--Diagnosis
AND (APCs.[Der _ Diagnosis _ All] LIKE '%K851%')
AND (case when apcep.[Primary _ Procedure _ Code]
LIKE '%J43[12389]%' and datediff(dd,apcs. Admission _ Date,[Primary _ Procedure _ Date])<=3 then 1 else 0 end+
case when apcep.[Procedure _ Code _ 2] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 2])<=3 then 1 else 0end +
case when apcep.[Procedure _ Code _ 3] LIKE '%J43[12389]%'
and datediff(dd,apcs.Admission _Date,[Procedure _ Date _ 3])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 4] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 4])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 5] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 5])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 6] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 6])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 7] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 7])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 8] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 8])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 9] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 9])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 10] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ ate,[Procedure _ Date _ 10])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 11] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 11])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 12] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _Date,[Procedure _ Date _ 12])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 13] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 13])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 14] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 14])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 15] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 15])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 16] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 16])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 17] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 17])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 18] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 18])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 19] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 19])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 20] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 20])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 21] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 21])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 22] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 22])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 23] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 23])<=3 then 1 else 0 end +
case when apcep.[Procedure _ Code _ 24] LIKE '%J43[12389]%' and datediff(dd,apcs.Admission _ Date,[Procedure _ Date _ 24])<=3 then 1 else 0 end)

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

— 45,745 outpatient attendances during 2018/19

— Age/sex std rate per 100,000 – 77.0

— Reduction opportunity – 45,745 (100%)

— Variation (age/sex std rates per 100,000):

— N-fold: 13.4

— 10th percentile – 11.5

— 25th percentile – 24.3

— 50th percentile – 56.8

— 90th percentile – 154.4

Codes

Procedure codes

U19.4 Exercise electrocardiography

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Outpatient

Coding logic

Procedure code in any position is:

U19.4

AND

Patient age >=19 years

SQL code

OPA.Der _ Procedure _ All LIKE '%U194%'
and isnull(OPA.Age _ at _ Start _ of _ Episode _ SUS,OPA.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like'%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%')
OR opa.Der _ Diagnosis _ All IS NULL)

Estimated activity

— 41 episodes during 2018/19

— Age/sex std rate per 100,000 – 0.1

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— Variation (age/sex std rates):

— N-fold – 4.5

— 10th percentile – 0.1

— 25th percentile – 0.1

— 50th percentile – 0.3

— 90th percentile – 0.5

Codes

Procedure codes

V38.2 Primary posterior interlaminar fusion of joint of lumbar spine

V38.3 Primary posterior fusion of joint of lumbar spine NEC

V38.4 Primary intertransverse fusion of joint of lumbar spine NEC

V38.5 Primary posterior interbody fusion of joint of lumbar spine

V38.6 Primary transforaminal interbody fusion of joint of lumbar spine

V40.4 Posterior instrumented fusion of lumbar spine NEC

Diagnosis codes

Back pain

M54.5 Low back pain

M54.9 Dorsalgia, unspecified

Exclusion codes:

M87.2 Osteonecrosis due to previous trauma

M40.0Postural kyphosis

M40.1Other secondary kyphosis

M40.2Other and unspecified kyphosis

M41.0Infantile idiopathic scoliosis

M41.1Juvenile idiopathic scoliosis

M41.2Other idiopathic scoliosis

M41.3Thoracogenic scoliosis

M41.4Neuromuscular scoliosis

M41.5Other secondary scoliosis

M41.8Other forms of scoliosis

M41.9Scoliosis, unspecified

M42.0 Juvenile osteochondrosis of spine

M42.1 Adult osteochondrosis of spine

M42.9 Spinal osteochondrosis, unspecified

M43.0 Spondylolysis

M43.1 Spondylolisthesis

M43.5 Other recurrent vertebral subluxation

M43.8 Other specified deforming dorsopathies

M43.9 Deforming dorsopathy, unspecified

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where the procedure code in dominant position is:

V38.2 OR

V38.3 OR

V38.4 OR

V38.5 OR

V38.6 OR

V40.4

AND

The diagnosis code in primary position is:

M54.5 OR

M54.9

AND

Any diagnosis code in any position is NOT:

M40.0 OR

M40.1 OR

M40.2 OR

M41.0 OR

M41.1 OR

M41.2 OR

M41.3 OR

M41.4 OR

M41.5 OR

M41.8 OR

M41.9 OR

M42.0 OR

M42.1 OR

M42.9 OR

M43.0 OR

M43.1 OR

M43.5 OR

M43.8 OR

M43.9 OR

M87.2

AND

Patient age >= 19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

(left(der.Spell _ Dominant _ Procedure,4) like '%V38[23456]%' or
left(der.Spell _ Dominant _ Procedure,4) like '%V404%')
and der.Spell _ Primary _ Diagnosis like '%M54[59]%'
and apcs.der _ diagnosis _ all not like '%M40[012]%'
and apcs.der _ diagnosis _ all not like '%M41[01234589]%'
and apcs.der _ diagnosis _ all not like '%M42[019]%'
and apcs.der _ diagnosis _ all not like '%M43[01589]%'
and apcs.der _ diagnosis _ all not like '%M872%'
and
isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date) between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9] [0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%'
or apcs.der _ diagnosis _ all IS NULL

SQL code

left(der.Spell_Dominant_Procedure,4) in ('T591','T592','T598','T599','T601','T602','T608','T609’)
and der.Spell_Primary_Diagnosis like '%M674%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in ('D151','D289') and (der.Spell_Primary_Diagnosis like 'H65[23]%’
or der.Spell_Primary_Diagnosis like 'H66[1-9]%') and (isnull(apcs.age_at_start_of_Spell_SUS, Der_Age_at_CDS_Activity_Date) between 0 and 18 or isnull(apcs.age_at_start_of_Spell_SUS, Der_Age_at_CDS_Activity_Date)between 7001 and 7007 )

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in ('H511','H512','H513','H518','H519')

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

For interventions with fewer than 10 episodes during 2018/19, the activity and coding has not been included.

SQL code

left(der.Spell_Dominant_Procedure,4) in ('Q072','Q074','Q078','Q079','Q082','Q088','Q089’) and
apcs.der_diagnosis_all not like '%O0[0-8]%' and
apcs.der_diagnosis_all not like '%O6[0-9]%' and
apcs.der_diagnosis_all not like '%O7[0-5]%' and
apcs.der_diagnosis_all not like '%N81%

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

left(der.Spell_Dominant_Procedure,4) in ('A521','A522','A528','A529','A577','A735','V544’) and left(der.spell_primary_diagnosis,4) in ('M518','M519','M545','M549') and (apcs.der_procedure_all like '%Z67[567]%' or apcs.der_procedure_all like '%Z993%')

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

(der.Spell_Dominant_Procedure in ('W821','W822','W823','W828','W829','W851','W852','W853','W858','W859','W861+KNEE','W831+KNEE','W832+KNEE','W833+KNEE','W834+KNEE','W835+KNEE','W836+KNEE','W837+KNEE','W838+KNEE','W839+KNEE','W841+KNEE','W842+KNEE','W843+KNEE','W844+KNEE','W879') or (der.Spell_Dominant_Procedure = 'W901' and (apcs.der_procedure_all like '%O132%' or apcs.der_procedure_all like '%Z12[123]%' or apcs.der_procedure_all like '%Z504%' or apcs.der_procedure_all like '%Z577%' or apcs.der_procedure_all like '%Z58%' or apcs.der_procedure_all like '%Z77[12489]%' or apcs.der_procedure_all like '%Z78[1236789]%' or apcs.der_procedure_all like '%Z84[456]%' or apcs.der_procedure_all like '%Z851%' or apcs.der_procedure_all like '%Z904%’))) and (isnull(APCS.Age_At_Start_of_Spell_SUS,APCS.Der_Age_at_CDS_Activity_Date) between 19 and 120) and der.Spell_Primary_Diagnosis like 'M1[57]%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

This coding is relevant for suspected meniscal tears and when symptoms are suggestive of osteoarthritis.

Estimated activity

• 80,315 episodes during 2018/19
• Age/sex std rate per 100,000 – 135.2
• Reduction opportunity based on 25th percentile of activity across CCGs: not calculated
• Variation (age/sex std rates):
  • N-fold – 107.4
  • 10th percentile – 4.2
  • 25th percentile – 12.6
  • 50th percentile – 51.7
  • 90th percentile – 447.0

Codes

Procedure codes

U133: MRI bone/joint:

With site codes –

Z84.6 Knee joint

O13.2 Knee NEC

Diagnosis codes

Note – these diagnosis codes have been provided, but not reflected in the coding logic and example SQL code below, as the sparseness of OP diagnosis data means that this is less helpful in an OP setting. It is included here for information.

 M170: Primary gonarthrosis, bilateral

M171 Other primary gonarthrosis, incl:

Primary gonarthrosis:

• NOS
• Unilateral

M179: Gonarthrosis, unspecified

 Exclusions

M000, 1,2, 8 &9 infection

M050-9 rheumatoid

M060-9 inflammatory

M070-9 reactive

M020-9 arthropathies

M030-9 post infection

M100-9 gout

M120-9 other arthropathies

M130-9 other arthritis

M140-9 diabetic/ neuropathic

M150-9 polyarthrosis

M172, 3, 4 & 5: gonarthrosis resulting from trauma or other secondary

C402, 408, 409 neoplasm

D162 neoplasm

C765 neoplasm

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Outpatient

Coding logic

Procedure code in any position is:

U133

With procedure in any position:

Z84.6 OR

O13.2

AND

Patient age >=19 years

SQL code

opa.Der _ Procedure _ All like '%U133%'
and (opa.Der _ Procedure _ All like '%Z846%'
or opa.Der _ Procedure _ All like '%O132%')
and
ISNULL(opa.Age _ at _ Start _ of _ Episode _ SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%')
OR opa.Der _ Diagnosis _ All IS NULL)

What are we counting?

No coding is available for the procedure or indications.

Estimated activity

• 253,956 episodes during 2018/19
• Age/sex std rate per 100,000 – 427.5
• Reduction opportunity based on 25th percentile of activity across CCGs: not calculated
• Variation (age/sex std rates):
  • N-fold – 50.6
  • 10th percentile – 23.1
  • 25th percentile – 55.5
  • 50th percentile – 183.0
  • 90th percentile – 1,168.3

Codes

Procedure codes

U05.4 Computed tomography of spine

U05.5 Magnetic resonance imaging of spine

U13.2 Ultrasound of bone

U13.3 Magnetic resonance imaging of bone

U13.5 Plain x-ray of bone

U13.6 Computed tomography of bone

U21.1 Magnetic resonance imaging NEC

U21.2 Computed tomography NEC

U21.6 Ultrasound scan NEC

U21.7 Plain x-ray NEC

Z66.5 Lumbar vertebra

O16.2 Spine NEC

Diagnosis codes

No

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Outpatient

Coding logic

Procedure code in any position is:

U05.4 OR

U05.5 OR

U13.2 OR

U13.3 OR

U13.5 OR

U13.6 OR

U21.1 OR

U21.2 OR

U21.6 OR

U21.7

With procedure code in any position:

Z66.5 OR

O16.2

AND

Patient age >=19 years

SQL code

(opa.Der _ Procedure _ All like '%U05[45]%' or ((opa.Der _ Procedure _ All like '%U13[2356]%'or opa.Der _ Procedure _ All like '%U21[1267]%')
and (opa.Der _ Procedure _ All like '%Z665%' or opa.Der _ Procedure _ All like '%O162%')))
and ISNULL(opa.Age _ at _ Start _ of _ Episode _SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%') OR opa.Der _ Diagnosis _ All IS NULL)

Estimated activity

• 2,291 episodes during 2018/19
• Age/sex std rate per 100,000 – 3.9
• Reduction opportunity: 1,353 (59%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 8.7
  • 10th percentile – 1.0
  • 25th percentile – 1.7
  • 50th percentile – 3.5
  • 90th percentile – 8.5

Codes

Procedure codes

V33.1 Primary laminectomy excision of lumbar intervertebral disc

V33.2 Primary fenestration excision of lumbar intervertebral disc

V33.3 Primary anterior excision of lumbar intervertebral disc and interbody fusion of joint of lumbar spine

V33.4 Primary anterior excision of lumbar intervertebral disc NEC

V33.5 Primary anterior excision of lumbar intervertebral disc and posterior graft fusion of joint of lumbar spine

V33.6 Primary anterior excision of lumbar intervertebral disc and posterior instrumentation of lumbar spine

V33.7 Primary microdiscectomy of lumbar intervertebral disc V33.8 Other specified excision of unspecified intervertebral disc

V33.9 Unspecified excision of unspecified intervertebral disc

V35.1 Primary excision of intervertebral disc NEC

V35.8 Other specified excision of unspecified intervertebral disc

V35.9 Unspecified excision of unspecified intervertebral disc

V51.1 Primary direct lateral excision of lumbar intervertebral disc and interbody fusion of joint of lumbar spine

V51.8 Other specified other primary excision of lumbar intervertebral disc

V51.9 Unspecified other primary excision of lumbar intervertebral disc

V52.1 Enzyme destruction of intervertebral disc

V52.2 Destruction of intervertebral disc NEC

V52.5 Aspiration of intervertebral disc NEC

V52.8 Other specified other operations on intervertebral disc

V52.9 Unspecified other operations on intervertebral disc

V58.3 Primary automated percutaneous mechanical excision of lumbar intervertebral disc

V58.8 Other specified

V58.9 Unspecified

V60.3 Primary percutaneous decompression using coblation to lumbar intervertebral disc

V60.8 Other specified primary percutaneous decompression using coblation to intervertebral disc

V60.9 Unspecified primary percutaneous decompression using coblation to intervertebral disc

V55.1 One level of spine

V55.2 Two levels of spine

V55.3 Greater than two levels of spine

V55.8 Other specified levels of spine

V55.9 Unspecified levels of spine

Diagnosis codes

M51.0 Lumbar and other intervertebral disc disorders with myelopathy

M51.1 Lumbar and other intervertebral disc disorders with radiculopathy

M54.1 Radiculopathy

M54.3 Sciatica

M54.4 Lumbago with sciatica

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where the procedure code in dominant position is:

V33.1 OR

V33.2 OR

V33.3 OR

V33.4 OR

V33.5 OR

V33.6 OR

V33.7 OR

V33.8 OR

V33.9 OR

V35.1 OR

V35.8 OR

V35.9 OR

V51.1 OR

V51.8 OR

V51.9 OR

V52.1 OR

V52.2 OR

V52.5 OR

V52.8 OR

V52.9 OR

V58.3 OR

V58.8 OR

V58.9 OR

V60.3 OR

V60.8 OR

V60.9 OR

AND

Procedure code in any position is:

V55.1

V55.2

V55.3

V55.8

V55.9

AND

Primary diagnosis code is:

M51.0 OR

M51.1 OR

M54.1 OR

M54.3 OR

M54.4

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

left(der.Spell _ Dominant _ Procedure,4) in ('V331','V332','V333','V334','V335','V336','V337','V3
38','V339','V351','V358','V359','V511','V518','V519','
V521','V522','V525','V528','V529','V583','V588','V589
','V603','V608','V609')
and (der.Spell _ Primary _ Diagnosis like '%M51[01]%' or der.Spell _ Primary _ Diagnosis like '%M54[134]%')
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')
AND (der _ procedure _ all LIKE '%V55[12389]%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

• 1,612 episodes during 2018/19
• Age/sex std rate per 100,000 – 2.7
• Reduction opportunity: 1,379 (86%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 23.2
  • 10th percentile – 0.3
  • 25th percentile – 0.7
  • 50th percentile – 2.0
  • 90th percentile – 7.7

Codes

Procedure codes

V485: Radiofrequency controlled thermal denervation of spinal facet joint of lumbar vertebra

V487: Radiofrequency controlled thermal denervation of spinal facet joint of vertebra NEC

Z675: Lumbar intervertebral joint

Z676: Lumbosacral joint

Z677: Sacrococcygeal joint

Z993: Intervertebral disc of lumbar spine

Diagnosis codes

M518: Other specified intervertebral disc disorders

M519: Intervertebral disc disorder, unspecified

M545: Low back pain

M549: Dorsalgia, unspecified

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where procedure code in dominant position is:

V48.5 OR

V48.7

AND

Procedure code in any position is

Z675 OR

Z676 OR

Z677 OR

Z993

AND

Primary diagnosis code is:

M518 OR

M519 OR

M545 OR

M549

AND

Primary diagnosis code is:

M518 OR

M519 OR

M545 OR

M549

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

der.Spell _ Dominant _ Procedure like'%V48[57]%'
and left(der.spell _ primary _ diagnosis,4) in ('M518','M519','M545','M549')
and (apcs.der _ procedure _ all like '%Z67[567]%' or apcs.der _ procedure _ all like '%Z993%')
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like
'%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

• 13,352 attendances during 2018/19
• Age/sex std rate per 100,000 – 22.5
• Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.
• Variation (age/sex std rates):
  • N-fold – 41.2
  • 10th percentile – 1.4
  • 25th percentile – 4.0
  • 50th percentile – 12.1

Codes

Procedure codes

U13.3 Magnetic resonance imaging of bone

U21.1 Magnetic resonance imaging NEC

Z84.3 Hip joint

Z84.8 Specified joint of pelvis or upper leg NEC

Z84.9 Joint of pelvis or upper leg NEC

Z90.2 Hip NEC

Diagnosis codes

Note – these diagnosis codes have been provided, but not reflected in the coding logic and example SQL code below, as the sparseness of OP diagnosis data means that this is less helpful in an OP setting. It is included here for information.

M160: primary coxarthrosis

M161: other primary coxarthrosis, incl:

Primary coxarthrosis:

• NOS
• Unilateral

M169: Coxarthrosis, unspecified

Exclusions

M00 Pyogenic arthritis

M02 Reactive arthropathies

M03* Postinfective and reactive arthropathies in diseases

classified elsewhere

M05 Seropositive rheumatoid arthritis

M06 Other rheumatoid arthritis

M07* Psoriatic and enteropathic arthropathies

M10 Gout

M11 Other crystal arthropathies

M12 Other specific arthropathies

M13 Other arthritis

M14* Arthropathies in other diseases classified elsewhere

M15 Polyarthrosis

Incl.:

arthrosis with mention of more than one site

Excl.:

bilateral involvement of single joint (M16-M19)

M16.2 Coxarthrosis resulting from dysplasia, bilateral

M16.3 Other dysplastic coxarthrosis

Incl.:

Dysplastic coxarthrosis:

* NOS

* unilateral

M16.4 Post-traumatic coxarthrosis, bilateral

M16.5 Other post-traumatic coxarthrosis

Incl.:

Post-traumatic coxarthrosis:

* NOS

* unilateral

C40.2 Long bones of lower limb

C40.8 Overlapping lesion of bone and articular cartilage oflimbs

C40.9 Bone and articular cartilage of limb, unspecified

D16.2 Long bones of lower limb – benign neoplasm

C76.5 Lower limb – malignant neoplasm

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Outpatients

Coding logic

Procedure code in any position is:

U13.3

U21.1

AND

Procedure code in any position:

Z84.3 OR

Z84.8 OR

Z84.9 OR

Z90.2

AND

Patient age >= 19 years

SQL code

opa.Der _ Procedure _ All like '%U133%' or
opa.Der _ Procedure _ All like '%U211%')
and (opa.Der _ Procedure _ All like '%Z84[389]%'
or opa.Der _ Procedure _ All like '%Z902%')
and
ISNULL(opa.Age _ at _ Start _ of _ Episode _ SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0- 9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%')
OR opa.Der _ Diagnosis _ All IS NULL)

Estimated activity

We have been unable to accurately identify diagnostic and procedure codes and produce activity figures. Exploring the option of using linked Diagnostic Imaging Dataset (DIDs) data, available later this year.

Estimated activity

We have been unable to accurately identify diagnostic and procedure codes and produce activity figures. Exploring the option of using linked Diagnostic Imaging Dataset (DIDs) data, available later this year.

Estimated activity

No coding is available for the procedure, diagnoses or indications.

Estimated activity

— 2,778 episodes during 2018/19

— Age/sex std rate per 100,000 – 4.7

— Reduction opportunity: 1,426 (51%) based on 25^th percentile of activity across CCGs.

— Variation (age/sex std rates):

— N-fold – 5.5

— 10th percentile – 1.6

— 25th percentile – 2.5

— 50th percentile – 4.4

— 90th percentile – 8.9

Procedure codes

E20.1 Total adenoidectomy

E20.4 Suction diathermy adenoidectomy

E20.8 Other specified operations on adenoid

E20.9 Unspecified operations on adenoid

With:

D15.1 Myringotomy with insertion of ventilation tube through tympanic membrane

Diagnosis codes

H65.2 Chronic serous otitis media

H65.3 Chronic mucoid otitis media

H65.4 Other chronic nonsuppurative otitis media

H65.9 Unspecified nonsuppurative otitis media

H66.1 Chronic tubotympanic suppurative otitis media

H66.3 Other chronic suppurative otitis media

H66.4 Suppurative otitis media, unspecified

H66.9 Otitis media, unspecified

H68.1 Obstruction of Eustachian tube

H69.8 Other specified disorders of Eustachian tube

H69.9 Unspecified Eustachian tube disorder

Exclusions:

G47.3 Sleep apnoea

J32.0 Chronic maxillary sinusitis

J32.1 Chronic frontal sinusitis

J32.2 Chronic ethmoidal sinusitis

J32.3 Chronic sphenoidal sinusitis

J32.4 Chronic pansinusitis

J32.8 Other chronic sinusitis

J32.9 Chronic sinusitis, unspecified

Q35.1 Cleft hard palate

Q35.3 Cleft soft palate

Q35.5 Cleft hard palate with cleft soft palate

Q35.7 Cleft uvula

Q35.9 Cleft palate, unspecified

Q37.0 Cleft hard palate with bilateral cleft lip

Q37.1 Cleft hard palate with unilateral cleft lip

Q37.2 Cleft soft palate with bilateral cleft lip

Q37.3 Cleft soft palate with unilateral cleft lip

Q37.4 Cleft hard and soft palate with bilateral cleft lip

Q37.5 Cleft hard and soft palate with unilateral cleft lip

Q37.8 Unspecified cleft palate with bilateral cleft lip

Q37.9 Unspecified cleft palate with unilateral cleft lip

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Procedure codes in any position are:

E20.1 OR

E20.4 OR

E20.8 OR

E20.9

AND

D15.1

AND

Primary diagnosis code is:

H65.2

H65.3

H65.4

H65.9

H66.1

H66.3

H66.4

H66.9

H68.1

H69.8

H69.9

AND

Diagnosis codes in any position are NOT:

G47.3 OR

J32.0 OR

J32.1 OR

J32.2 OR

J32.3 OR

J32.4 OR

J32.8 OR

J32.9 OR

Q35.1 OR

Q35.3 OR

Q35.5 OR

Q35.7 OR

Q35.9 OR

Q37.0 OR

Q37.1 OR

Q37.2 OR

Q37.3 OR

Q37.4 OR

Q37.5 OR

Q37.8 OR

Q37.9

AND

Patient age <19

AND

APCS.Admission_Method not like (‘2%’)

SQL code

apcs.der _ procedure _ all like '%E20[1489]%'
and apcs.der _ procedure _ all like '%D151%'
and (der.Spell _ Primary _ Diagnosis like 'H65[2349]%'
OR der.Spell _ Primary _ Diagnosis like 'H66[1349]%'
OR der.Spell _ Primary _ Diagnosis like 'H681%'
OR der.Spell _ Primary _ Diagnosis like 'H69[89]%')
and (apcs.der _ diagnosis _ all not like '%G473%' and apcs.der _ diagnosis _ all not like '%J32%' and apcs.der _ diagnosis _ all not like '%Q3[57]%')
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)<=18
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

SQL code

left(der.Spell_Dominant_Procedure,4) in ('S063','S064','S065','S066','S067','S068','S069','S081','S082','S083','S088','S089','S091','S092’,
'S093','S094','S095','S098','S099','S101','S102','S111','S112','D021','D022','D028','D029') and apcs.der_diagnosis_all not like '%Z858%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

• 54,764 episodes during 2018/19
• Age/sex std rate per 100,000 – 92.2
• Reduction opportunity: 8,168 (15%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 1.5
  • 10th percentile – 75.0
  • 25th percentile – 82.4
  • 50th percentile – 91.8
  • 75th percentile – 110.8

Codes

Procedure codes

T20.1 Primary repair of inguinal hernia using insert of natural material

T20.2 Primary repair of inguinal hernia using insert of prosthetic material

T20.3 Primary repair of inguinal hernia using sutures

T20.4 Primary repair of inguinal hernia and reduction of sliding hernia

T20.8 Other specified primary repair of inguinal hernia

T20.9 Unspecified primary repair of inguinal hernia

Diagnosis codes

K40.2 Bilateral inguinal hernia, without obstruction or gangrene

K40.9 Unilateral or unspecified inguinal hernia, without obstruction or gangrene

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g.patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where procedure code in dominant position is:

T20.1 OR

T20.2 OR

T20.3 OR

T20.4 OR

T20.8 OR

T20.9

AND

Primary diagnosis code is:

K402 OR

K409

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

left(der.Spell _ Dominant _ Procedure,3)='T20'
and der.Spell _ Primary _ Diagnosis like'K40[29]%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%'
or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

W(i) – scans for shoulder pain:

— 128,809 attendances during 2018/19

— Age/sex std rate per 100,000 – 216.8

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— Variation (age/sex std rates):

— N-fold – 84.2

— 10th percentile – 7.0

— 25th percentile – 18.7

— 50th percentile – 71.0

— 90th percentile – 579.7

W(ii) – image guided injections for shoulder pain:

— 2,934 attendances during 2018/19

— Age/sex std rate per 100,000 – 4.9

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— Variation (age/sex std rates):

— N-fold – 43.4

— 10th percentile – 0.4

— 25th percentile – 0.8

— 50th percentile – 2.1

— 90th percentile – 17.5

Codes

Procedure codes

W(i) – scans for shoulder pain:

U13.2 Ultrasound of bone

U13.3 Magnetic resonance imaging of bone

U13.4 Plain x-ray of joint

U13.5 Plain x-ray of bone

U13.6 Computed tomography of bone

U21.1 Magnetic resonance imaging NEC

U21.2 Computed tomography NEC

U21.6 Ultrasound scan NEC

U21.7 Plain x-ray NEC

Z81.2 Acromioclavicular joint

Z81.3 Glenohumeral joint

Z81.4 Shoulder joint

Z81.8 Specified joint of shoulder girdle or arm NEC

Z81.9 Joint of shoulder girdle or arm NEC

Z89.1 Shoulder NEC

Z54.2 Rotator cuff of shoulder

Z54.8 Specified muscle of shoulder or upper arm NEC

Z54.9 Muscle of shoulder or upper arm NEC

Z68.8 Specified bone of shoulder girdle NEC

Z68.9 Bone of shoulder girdle NEC

W(ii) – image guided injections for shoulder pain:

U13.2 Ultrasound of bone

U13.3 Magnetic resonance imaging of bone

U13.4 Plain x-ray of joint

U13.5 Plain x-ray of bone

U13.6 Computed tomography of bone

U21.1 Magnetic resonance imaging NEC

U21.2 Computed tomography NEC

U21.6 Ultrasound scan NEC

U21.7 Plain x-ray NEC

Z81.2 Acromioclavicular joint

Z81.3 Glenohumeral joint

Z81.4 Shoulder joint

Z81.8 Specified joint of shoulder girdle or arm NEC

Z81.9 Joint of shoulder girdle or arm NEC

Z89.1 Shoulder NEC

Z54.2 Rotator cuff of shoulder

Z54.8 Specified muscle of shoulder or upper arm NEC

Z54.9 Muscle of shoulder or upper arm NEC

Z68.8 Specified bone of shoulder girdle NEC

Z68.9 Bone of shoulder girdle NEC

W90.3 Injection of therapeutic substance into joint + Shoulder

W90.4 Injection into joint NEC + Shoulder

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Outpatient

Coding logic

W(i) – scans for shoulder pain:

Where the procedure code in any position is:

U13.2 OR

U13.3 OR

U13.4 OR

U13.5 OR

U13.6 OR

U21.1 OR

U21.2 OR

U21.6 OR

U21.7

AND

The procedure code in any position is:

Z81.2 OR

Z81.3 OR

Z81.4 OR

Z81.8 OR

Z81.9 OR

Z89.1 OR

Z54.2 OR

Z54.8 OR

Z54.9 OR

Z68.8 OR

Z68.9

AND

The procedure code in any position is not:

W903+Shoulder OR

W904+Shoulder

AND

Patient age >= 19 years

W(ii) – image guided injections for shoulder pain:

Where the procedure code in any position is:

U13.2 OR

U13.3 OR

U13.4 OR

U13.5 OR

U13.6 OR

U21.1 OR

U21.2 OR

U21.6 OR

U21.7

AND

The procedure code in any position is:

Z81.2 OR

Z81.3 OR

Z81.4 OR

Z81.8 OR

Z81.9 OR

Z89.1 OR

Z54.2 OR

Z54.8 OR

Z54.9 OR

Z68.8 OR

Z68.9

AND

The procedure code in any position is:

W903+Shoulder OR

W904+Shoulder

AND

Patient age >= 19 years

SQL code

W(i) – scans for shoulder pain:
(opa.Der _ Procedure _ All like '%U13[23456]%'
or opa.Der _ Procedure _ All like '%U21[1267]%')
and
(opa.Der _ Procedure _ All like '%Z81[23489]%'
or opa.Der _ Procedure _ All like '%Z891%' or
opa.Der _ Procedure _ All like '%Z54[289]%' or
opa.Der _ Procedure _ All like '%Z68[89]%')
AND opa.Der _ Procedure _ All NOT LIKE '%W90[34]%'
and
ISNULL(opa.Age _ at _ Start _ of _ Episode _ SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date) between 19 and 120

W(ii) – image guided injections for shoulder pain:
(opa.Der _ Procedure _ All like '%U13[23456]%'
or opa.Der _ Procedure _ All like '%U21[1267]%')
and
(opa.Der _ Procedure _ All like '%Z81[23489]%'
or opa.Der _ Procedure _ All like '%Z891%' or
opa.Der _ Procedure _ All like '%Z54[289]%' or
opa.Der _ Procedure _ All like '%Z68[89]%')
AND opa.Der _ Procedure _ All LIKE '%W90[34]%'
and
ISNULL(opa.Age _ at _ Start _ of _ Episode _ SUS,opa.Der _ Age _ at _ CDS _ Activity _ Date) between 19 and 120

Global cancer exclusion

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%')
OR opa.Der _ Diagnosis _ All IS NULL)

SQL code

(left(der.Spell_Dominant_Procedure,4) in ('F324','F325','F326')
or (left(der.Spell_Dominant_Procedure,4) = 'F328' and der.Spell_Primary_Diagnosis like '%R065%')) and der.Spell_Primary_Diagnosis not like '%G473%' and isnull(APCS.Age_At_Start_of_Spell_SUS,APCS.Der_Age_at_CDS_Activity_Date) between 19 and 120

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

• 14,561 episodes during 2018/19
• Age/sex std rate per 100,000 – 24.5
• Reduction opportunity: 4,363 (30%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 2.2
  • 10th percentile – 15.2
  • 25th percentile – 18.3
  • 50th percentile – 23.6
  • 90th percentile – 33.3

Codes

Procedure codes

M61.1 Total excision of prostate and capsule of prostate

M61.2 Retropubic prostatectomy

M61.3 Transvesical prostatectomy

M61.4 Perineal prostatectomy

M61.8 Other specified open excision of prostate

M61.9 Unspecified open excision of prostate

M64.1 Open resection of outlet of male bladder

M65.1 Endoscopic resection of prostate using electrotome

M65.2 Endoscopic resection of prostate using punch

M65.3 Endoscopic resection of prostate NEC

M65.4 Endoscopic resection of prostate using laser

M65.5 Endoscopic resection of prostate using vapotrode

M65.8 Other specified endoscopic resection of outlet of male bladder

M65.9 Unspecified endoscopic resection of outlet of male bladder

M66.1 Endoscopic sphincterotomy of external sphincter of male bladder

M66.2 Endoscopic incision of outlet of male bladder NEC

M68.1 Endoscopic insertion of prostatic stent

M68.3 Endoscopic insertion of prosthesis to compress lobe of prostate

Diagnosis codes

N40 Hyperplasia of prostate

Exclude:

C61 Malignant neoplasm of prostate

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Male

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Procedure code in dominant position is:

M61.1 OR

M61.2 OR

M61.3 OR

M61.4 OR

M61.8 OR

M61.9 OR

M64.1 OR

M65.2 OR

M65.3 OR

M65.4 OR

M65.5 OR

M65.8 OR

M65.9 OR

M66.1 OR

M66.2 OR

M68.1 OR

M68.3

AND

Primary diagnosis code is:

N40 Hyperplasia of prostate

AND

Diagnosis code in any position is NOT:

C61 Malignant neoplasm of prostate

AND

Patient gender is male

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

l(left(der.Spell _ Dominant _ Procedure,4) like '%M61[123489]%'
or left(der.Spell _ Dominant _ Procedure,4)like '%M641%'
or left(der.Spell _ Dominant _ Procedure,4)like '%M65[1234589]%'
or left(der.Spell _ Dominant _ Procedure,4)like '%M66[12]%'
or left(der.Spell _ Dominant _ Procedure,4)like '%M68[13]%')
and der.Spell _ Primary _ Diagnosis like'%N40%'
and apcs.sex=1
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%'
or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

• 12,610 episodes during 2018/19
• Age/sex std rate per 100,000 – 21.2
• Reduction opportunity: 2,388 (19%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 1.7
  • 10th percentile – 15.4
  • 25th percentile – 17.7
  • 50th percentile – 20.9
  • 90th percentile – 26.9

Codes

Procedure codes

Y76.1 Functional endoscopic sinus surgery

Y76.2 Functional endoscopic nasal surgery

E12.1 Ligation of maxillary artery using sublabial approach

E12.2 Drainage of maxillary antrum using sublabial approach

E12.3 Irrigation of maxillary antrum using sublabial approach

E12.4 Transantral neurectomy of vidian nerve using sublabial approach

E12.8 Other specified operations on maxillary antrum using sublabial approach

E12.9 Unspecified operations on maxillary antrum using sublabial approach

E13.1 Drainage of maxillary antrum NEC

E13.2 Excision of lesion of maxillary antrum

E13.3 Intranasal antrostomy

E13.4 Biopsy of lesion of maxillary antrum (we will leave in unless we hear otherwise)

E13.5 Closure of fistula between maxillary antrum and mouth

E13.6 Puncture of maxillary antrum

E13.7 Neurectomy of vidian nerve NEC

E13.8 Other specified other operations on maxillary antrum

E13.9 Unspecified other operations on maxillary antrum

E14.1 External frontoethmoidectomy

E14.2 Intranasal ethmoidectomy

E14.3 External ethmoidectomy

E14.4 Transantral ethmoidectomy

E14.5 Bone flap to frontal sinus

E14.6 Trephine of frontal sinus

E14.7 Median drainage of frontal sinus

E14.8 Other specified operations on frontal sinus

E14.9 Unspecified operations on frontal sinus

E15.1 Drainage of sphenoid sinus

E15.2 Puncture of sphenoid sinus

E15.3 Repair of sphenoidal sinus

E15.4 Excision of lesion of sphenoid sinus

E15.8 Other specified operations on sphenoid sinus

E15.9 Unspecified operations on sphenoid sinus

E16.1 Frontal sinus osteoplasty

E16.2 Drainage of frontal sinus NEC

E16.8 Other specified other operations on frontal sinus

E16.9 Unspecified other operations on frontal sinus

E17.1 Excision of nasal sinus NEC

E17.2 Excision of lesion of nasal sinus NEC

E17.3 Biopsy of lesion of nasal sinus NEC

E17.4 Lateral rhinotomy into nasal sinus NEC

E17.8 Other specified operations on unspecified nasal sinus

E17.9 Unspecified operations on unspecified nasal sinus

E08.1 Polypectomy of internal nose

Diagnosis codes

J32.0 Chronic maxillary sinusitis

J32.1 Chronic frontal sinusitis

J32.2 Chronic ethmoidal sinusitis

J32.3 Chronic sphenoidal sinusitis

J32.4 Chronic pansinusitis

J32.8 Other chronic sinusitis

J32.9 Chronic sinusitis, unspecified

J33.0 Polyp of nasal cavity

J33.1 Polypoid sinus degeneration

J33.8 Other polyp of sinus

J33.9 Nasal polyp, unspecified

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Patients of all ages

Exclude any patients admitted as a non-elective admission

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where the procedure code in any position:

Y76.1 OR

Y76.2 OR

E12.1 OR

E12.2 OR

E12.3 OR

E12.4 OR

E12.8 OR

E12.9 OR

E13.1 OR

E13.2 OR

E13.3 OR

E13.4 OR

E13.5 OR

E13.6 OR

E13.7 OR

E13.8 OR

E13.9 OR

E14.1 OR

E14.2 OR

E14.3 OR

E14.4 OR

E14.5 OR

E14.6 OR

E14.7 OR

E14.8 OR

E14.9 OR

E15.1 OR

E15.2 OR

E15.3 OR

E15.4 OR

E15.8 OR

E15.9 OR

E16.1 OR

E16.2 OR

E16.8 OR

E16.9 OR

E17.1 OR

E17.2 OR

E17.3 OR

E17.4 OR

E17.8 OR

E17.9 OR

E08.1

AND

Primary diagnosis code is:

J32.0 OR

J32.1 OR

J32.2 OR

J32.3 OR

J32.4 OR

J32.8 OR

J32.9 OR

J33.0 OR

J33.1 OR

J33.8 OR

J33.9

AND

APCS.Admission_Method not like (‘2%’)

SQL code

apcs.der _ procedure _ all like '%Y76[12]%'
OR apcs.der _ procedure _ all like '%E1[2-7][1-9]%'
OR apcs.der _ procedure _ all like '%E081%')
and der.Spell _ Primary _ Diagnosis like 'J3[23]%'
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

Estimated activity

• 14,456 episodes during 2018/19
• Age/sex std rate per 100,000 – 24.3
• Reduction opportunity: 3,092 (21%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 2.1
  • 10th percentile – 16.2
  • 25th percentile – 19.9
  • 50th percentile – 24.3
  • 90th percentile – 34.4

Codes

Procedure codes

Surgical treatments

M09.4 Endoscopic extraction of calculus of kidney NEC

M09.8 Other specified

M16.4 Percutaneous nephrolithotomy NEC

M26.1 Nephroscopic laser fragmentation of calculus of ureter

M26.2 Nephroscopic fragmentation of calculus of ureter NEC

M26.3 Nephroscopic extraction of calculus of ureter

M27.1 Ureteroscopic laser fragmentation of calculus of ureter

M27.2 Ureteroscopic fragmentation of calculus of ureter NEC

M27.3 Ureteroscopic extraction of calculus of ureter

M27.8 Other specified

M28.1 Endoscopic laser fragmentation of calculus of ureter NEC

M28.2 Endoscopic fragmentation of calculus of ureter NEC

M28.3 Endoscopic extraction of calculus of ureter NEC

M28.4 Endoscopic catheter drainage of calculus of ureter

M28.5 Endoscopic drainage of calculus of ureter by dilation of ureter

M28.8 Other specified

M28.9 Unspecified

Diagnosis codes

N20.0 Calculus of kidney

N20.1 Calculus of ureter

N20.2 Calculus of kidney with calculus of ureter

N20.9 Urinary calculus, unspecified

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Where procedure code in dominant position is:

M09.4 OR

M09.8 OR

M16.4 OR

M26.1 OR

M26.2 OR

M26.3 OR

M27.1 OR

M27.2 OR

M27.3 OR

M27.8 OR

M28.1 OR

M28.2 OR

M28.3 OR

M28.4 OR

M28.5 OR

M28.8 OR

M28.9

AND

Primary diagnosis code is:

N20.0 OR

N20.1 OR

N20.2 OR

N20.9

AND

Patient age >=19 years

SQL code

(left(der.Spell _ Dominant _ Procedure,4) in ('M094','M098','M164','M261','M262','M263','M271','M2 72','M273','M278')
OR left(der.Spell _ Dominant _Procedure,3)='M28')
and der.Spell _ Primary _ Diagnosis like '%N20[0129]%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

SQL code

left(der.Spell_Dominant_Procedure,4) in ('F341','F342','F343','F344','F345','F346','F347','F348','F349','F361')
and apcs.der_diagnosis_all not like '%G47%' and apcs.der_diagnosis_all not like '%J36%’

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

SQL code

der.Spell_Dominant_Procedure in ('T692+HAND','T691+HAND','T698+HAND','T699+HAND','T701+HAND','T702+HAND’,
'T718+HAND','T719+HAND','T723+HAND','T728+HAND','T729+HAND','T711+HAND')
and
Isnull(APCS.Age_At_Start_of_Spell_SUS, Der_Age_at_CDS_Activity_Date) between 19 and 120 and der.Spell_Primary_Diagnosis like '%M653%'

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

• 575,375 attendances during 2018/19
• Age/sex std rate per 100,000 – 968.5
• Reduction opportunity: Troponin testing is part of the COVID-19 testing protocol when someone presents in emergency care and therefore it is inappropriate to set a threshold.
• Variation (age/sex std rates based on adjusted data):
  • N-fold – 16.7
  • 10th percentile – 116.6
  • 25th percentile – 386.6
  • 50th percentile – 990.7
  • 90th percentile – 1,951.8

Codes

Procedure codes

Emergency Care Dataset (ECDS) codes (SNOMED CT Identifier (SCTID)):

Troponin measurement: 105000003

Troponin I measurement: 121870001

Troponin T measurement: 121871002

Plasma troponin I measurement: 313724009

Serum troponin I measurement: 313616005

Plasma troponin T measurement: 314068007

Serum troponin T measurement: 166794009

Troponin T cardiac measurement: 105001004

High sensitivity cardiac troponin T measurement:

784261000000103

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Patients of all ages

Will the procedure be carried out in OP or as APC?

Emergency care

Coding logic

Investigation field contains one of the following SCTID codes:

105000003 or 121870001 or 121871002 or 313724009 or 313616005 or 314068007 or 166794009 or 105001004 or 784261000000103

SQL code

ecds.Der_EC_Investigation_All like '%105000003%'
or ecds.Der_EC_Investigation_All like '%121870001%'
or ecds.Der_EC_Investigation_All like '%121871002%'
or ecds.Der_EC_Investigation_All like '%313724009%'
or ecds.Der_EC_Investigation_All like '%313616005%'
or ecds.Der_EC_Investigation_All like '%314068007%'
or ecds.Der_EC_Investigation_All like '%166794009%'
or ecds.Der_EC_Investigation_All like '%105001004%'
or ecds.Der_EC_Investigation_All like '%784261000000103%'

Estimated activity

• 644,038 episodes during 2018/19
• Age/sex std rate per 100,000 – 1,084.1
• Reduction opportunity: 81,391 (13%) based on 25^th percentile of activity across CCGs.
• Variation (age/sex std rates):
  • N-fold – 1.6
  • 10th percentile – 884.6
  • 25th percentile – 986.1
  • 50th percentile – 1,112.7
  • 90th percentile – 1,387.6

Codes

Procedure codes

G16.1 Diagnostic fibreoptic endoscopic examination of oesophagus and biopsy of lesion of oesophagus

G16.2 Diagnostic fibreoptic endoscopic ultrasound examination of oesophagus

G16.3 Diagnostic fibreoptic insertion of Bravo pH capsule into oesophagus

G16.8 Other specified diagnostic fibreoptic endoscopic examination of oesophagus

G16.9 Unspecified diagnostic fibreoptic endoscopic examination of oesophagus

G19.1 Diagnostic endoscopic examination of oesophagus and biopsy of lesion of oesophagus using rigid oesophagoscope

G19.2 Diagnostic endoscopic insertion of Bravo pH capsule using rigid oesophagoscope

G19.8 Other specified diagnostic endoscopic examination of oesophagus using rigid oesophagoscope

G19.9 Unspecified diagnostic endoscopic examination of oesophagus using rigid oesophagoscope

G45.1 Fibreoptic endoscopic examination of upper gastrointestinal tract and biopsy of lesion of upper gastrointestinal tract

G45.2 Fibreoptic endoscopic ultrasound examination of upper gastrointestinal tract

G45.3 Fibreoptic endoscopic insertion of Bravo pH capsule into upper gastrointestinal tract

G45.4 Fibreoptic endoscopic examination of upper gastrointestinal tract and staining of gastric mucosa

G45.8 Other specified diagnostic fibreoptic endoscopic examination of upper gastrointestinal tract

G45.9 Unspecified diagnostic fibreoptic endoscopic examination of upper gastrointestinal tract

G65.1 Diagnostic endoscopic examination of jejunum and biopsy of lesion of jejunum

G65.8 Other specified diagnostic endoscopic examination of jejunum

G65.9 Unspecified diagnostic endoscopic examination of jejunum

G80.1 Diagnostic endoscopic examination of ileum and biopsy of lesion of ileum

G80.2 Wireless capsule endoscopy

G80.3 Diagnostic endoscopic balloon examination of ileum

G80.8 Other specified diagnostic endoscopic examination of ileum

G80.9 Unspecified diagnostic endoscopic examination of ileum

Diagnosis codes

Not available

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

[APC extract only]

Will the procedure be carried out in OP or as APC?

Outpatient and Admitted Patient Care

Coding logic

APC:

Procedure code in dominant position is:

G16.1 OR

G16.2 OR

G16.3 OR

G16.8 OR

G16.9 OR

G19.1 OR

G19.2 OR

G19.8 OR

G19.9 OR

G45.1 OR

G45.2 OR

G45.3 OR

G45.4 OR

G45.8 OR

G45.9 OR

G65.1 OR

G65.8 OR

G65.9 OR

G80.1 OR

G80.2 OR

G80.3 OR

G80.8 OR

G80.9

AND

Patient age >=19 years

AND

APCS.Admission_Method not like (‘2%’)

OPA:

Procedure code in any position is:

G16.1 OR

G16.2 OR

G16.3 OR

G16.8 OR

G16.9 OR

G19.1 OR

G19.2 OR

G19.8 OR

G19.9 OR

G45.1 OR

G45.2 OR

G45.3 OR

G45.4 OR

G45.8 OR

G45.9 OR

G65.1 OR

G65.8 OR

G65.9 OR

G80.1 OR

G80.2 OR

G80.3 OR

G80.8 OR

G80.9

AND

Patient age >=19 years

SQL code

APC extract
left(der.Spell _ Dominant _ Procedure,3) in ('G16','G19','G45','G65','G80')
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

OPA extract
left(der.Spell _ Dominant _ Procedure,3) in ('G16','G19','G45','G65','G80')
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date)between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)

OPA
((opa.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and opa.der _ diagnosis _ all not like '%D0%'
and opa.der _ diagnosis _ all not like '%D3[789]%'
and opa.der _ diagnosis _ all not like '%D4[012345678]%') OR opa.Der _ Diagnosis _ All IS NULL)

SQL code

left(der.Spell_Dominant_Procedure,4) in ('L832','L838','L839','L841','L842','L843','L844','L845','L846','L848','L849','L851','L852' ,'L853','L858','L859','L861','L862','L863','L868','L869','L871','L872','L873','L874','L875' ,'L876','L877','L878','L879','L881','L882','L883','L888','L889')
and der.Spell_Primary_Diagnosis like ('%I8[03]%')

Global cancer exclusion

APC
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and
apcs.der_diagnosis_all not like '%D0%' and
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

Estimated activity

• 303 episodes during 2018/19
• Age/sex std rate per 100,000 – 0.5
• Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.
• Variation (age/sex std rates):
  • N-fold – 7.6
  • 10th percentile – 0.2
  • 25th percentile – 0.4
  • 50th percentile – 0.7
  • 90th percentile – 1.8

Codes

Procedure codes

V44.4 Vertebroplasty of fracture of spine

V55.1 One level of spine

V55.2 Two levels of spine

V55.3 Greater than two levels of spine

V55.8 Other specified levels of spine

V55.9 Unspecified levels of spine

Diagnosis codes

M80.0 Postmenopausal osteoporosis with pathological fracture

M80.1 Postoophorectomy osteoporosis with pathological fracture

M80.2 Osteoporosis of disuse with pathological fracture

M80.3 Postsurgical malabsorption osteoporosis with pathological fracture

M80.4 Drug-induced osteoporosis with pathological fracture

M80.5 Idiopathic osteoporosis with pathological fracture

M80.8 Other osteoporosis with pathological fracture

M80.9 Unspecified osteoporosis with pathological fracture

(Note – cancer diagnoses are a global exclusion)

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

Coding logic

Procedure code in dominant position is:

V444

AND

Procedure code in any position is:

V55.1

V55.2

V55.3

V55.8

V55.9

AND

Primary diagnosis code is:

M80.0 OR

M80.1 OR

M80.2 OR

M80.3 OR

M80.4 OR

M80.5 OR

M80.8 OR

M80.9

AND

Patient age >= 19 years

SQL code

left(der.Spell _ Dominant _ Procedure,4)='V444'
and der.Spell _ Primary _ Diagnosis like '%M80%'
and isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date) between 19 and 120
AND (der _ procedure _ all LIKE '%V55[12389]%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9][0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%' or apcs.der _ diagnosis _ all IS NULL)