01 August 2013
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Q. What coding should I be doing in my practice?

A. Coding can be very simple or very complex. This is the simple approach. For coding to work, all staff in the practice needs to be on board. Hold a practice meeting to agree what to code and how to code it. Remember to document this meeting and claim internal professional competence credits for it. A sensible first step is to decide to code a limited number of important diseases, say five diseases. Agree a definition of the diseases you are going to code, agree the words you will use to describe these diseases and agree the coding system. The coding system decision is a no brainer. Use ICPC-2, The International Classification of Primary Care. A suggested start-up list, including the ICPC-2 code is as follows:

  • Diabetes insulin dependent T89
  • Diabetes non-insulin dependent T90
  • Chronic obstructive pulmonary disease R95
  • Heart failure K77
  • Atrial fibrillation/flutter K78

ICPC-2 works really well for coding major diseases such as these. If you want to code more granular diseases they may not be included in ICPC-2 and then you will need to use ICD-10, the World Health Organisation's International Classification of Diseases. For ICD-10, please see www.who.int/classifications/icd/en/ and for ICPC-2, if you Google 'ICPC-2' you will get a two page pdf of the classification that helps you find what you need. You can use your practice software system to search for people who already have these codes or are on medication suggesting they have these diseases. Many of the accredited systems have disease finders to help identify people with diabetes. It is a work in progress to identify new patients as they are diagnosed with your agreed list of diseases and code these correctly. Your practice support staff can help you to identify patients for coding, but the decision to code should be a doctor or a practice nurse decision. You don't want the wrong code showing up in a patient's electronic record. A practice commitment to code makes a good professional competence audit. Check and see how many patients with diabetes are coded, embark on a coding campaign and check again in six months time. Coding can also be complex and support research. ICPC-2 was designed to look at the process of care, so you could use it to code presenting complaints, clinical findings, clinical assessment and the care process. Try not to make up your own codes. Find something in ICPC-2 or ICD-10 that is close to what you want. You can't compare anything with anyone if you make up your own codes. If you are big into coding then you should considering joining the Irish Primary Care Research Network.

There is more information on coding on the GPIT section of the ICGP website, have a look at the sections 'Publications & Reports' and 'How To Leaflets' on www.gpit.ie.

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