The EBI programme is committed to continuous improvement, including enhancing the data underpinning the clinical guidance. There will be regular reviews of the coding, for example the programme team is exploring the potential link between EBI data with the Diagnostic Imaging Database (DID) and the Patient Level Information and Costing System (PLICS). This joint working with other datasets and improvement programmes will enable and ensure alignment of any developments, therefore reducing any duplication in work.
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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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 25th 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)