Coding Guidance for Proactive and Preventative Care Cardiovascular Disease GP Enhanced Service

When a patient is started on the CVD DES process practices should add the READ2 code below to the record 

Blood Pressure

GPs and their teams should record blood pressure using the usual data entry templates or structured data area used in their system, the following codes will be automatically detected by the reporting system.

Total cholesterol and HDL cholesterol

It is expected that existing automated laboratory coding for these blood tests will provide evidence that the appropriate tests have been undertaken the automated reporting looks for the following codes.

BMI

Whilst height and weight are needed to calculate BMI, it is only the BMI that will be detected for reporting and achievement purposes, GPIT systems have existing data entry templates or structured data area, that support this calculation and GPs should use these. Reporting looks for the presence of the following code with a value.

Smoking

Please use the smoking coding that exists on your system from the Quality and Outcomes framework. The DES recognises all these codes.

Diabetes UK risk score

GPs and their teams are asked to assess the patient and calculate a Diabetes UK Risk of Type 2 Diabetes Score to do get a risk score the following data items are needed:

However, achievement is only measured against the presence of the following code with a value.

Diabetes testing

Where the T2DM Risk Score is high (equal or greater than 16). There is a requirement to undertake blood testing to assess for diabetes it is preferred that this is an HbA1c, but the achievement rules do accept a fasting blood glucose to allow for variation in local board policy around diabetes screening. It is expected that existing automated laboratory coding for these blood tests will provide evidence that the appropriate tests have been undertaken the automated reporting looks for the following codes.

Hba1c

Fasting blood glucose

ASSIGN CVD risk scoring

Practices should either use the Right Decision Service ASSIGN v2.0 risk calculator or (until the ASSIGN v2.0 codes are available in GP systems) the embedded ASSIGN v1.5 calculator on their GPIT System (Vision+ or BlueBayCT), where no embedded calculator is available GMS Facilitator teams can provide an offline version of the ASSIGN v1.5 calculator. The codes that should be used are as follows (recognising that ASSIGN v2.0 codes are unique to the GPIT system in use).

ASSIGN V2.0

ASSIGN V1.5

A key part of the DES is that a member of the GP Practice team undertakes follow up with the patient to discuss the risk score; this should be captured by adding the following codes during a consultation.

This discussion must be recorded by adding the code  

9OhA. Cardiovascular disease risk assessment done

In addition, one outcome code must be recorded, depending on the ASSIGN score result: 

If the ASSIGN score is high (ASSIGN v1.5 ≥20 or ASSIGN v2.0 ≥10), add  

6C2.. Primary prevention of cardiovascular disease

If the ASSIGN score is low (ASSIGN v1.5 <20 or ASSIGN v2.0 <10), add 

67H.. Lifestyle counselling

Payment is predicated on having BOTH the “Cardiovascular disease risk assessment done” code and the appropriate one of the subsequent codes depending on the ASSIGN score result.

The following codes have been requested and will be available in EMIS PCS February Drug and Code update released after Release 9.0.2 is available. For OneAdvanced Vision the code and term will be available when SNOMED CT 41.6 is released. This code/Term can be used by practices to enable diary dates/recalls for those high risk patients who need repeat testing in 6months.