04 November 2019
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Q. The new Chronic Disease Programme is coming in 2020. We are worried that our coding of patient's chronic diseases is substandard. How can we improve it and use this to capture our chronic disease patients to optimise reimbursement?

The Chronic Disease Programme is due to start in January 2020. Phase one will focus on patients over the age of 75 and will be collecting disease data on type 2 diabetes, asthma, COPD, heart failure, ischaemic heart disease, cerebrovascular disease and atrial fibrillation. There is a benefit in coding disease and clinical encounters in general practice, not only for disease audits in practice, but the coding process also aids outside research.

Coding in practice works best when everyone embraces it, which ultimately ensures that your entire patient population will be included. As we move to more electronic transfer of patient information, there is increased need to have more transferred information standardised, so disease and clinical encounter information can be machine-read, improving the interoperability between different computer systems.

If your coding is not up to speed, consider focusing as a starting point on patients over the age of 75 with the diseases listed in the Table. This could be undertaken as a practice audit and will provide added bonus CPD points.All accredited GP software have the capability to code in both ICPC2 and ICD-10 though there is some confusion as to which system should be used. Ideally both systems used together will give a better representation of your health data. The ICD-10 gives the past medical history and ICPC-2 gives you a view of the history of presenting complaint.

Capture the ICD-10 codes from discharge letters as they come in and code patient encounters using ICPC 2. If everyone in the practice adapts to this process, your disease registers will be up to date in no time.

ICPC-2: The International Classification of Primary Care 2 is the World Health Organization (WHO)-approved coding terminology for the recording of data in primary care. ICPC was designed as an epidemiological tool to enable healthcare providers to use a single aggregation terminology system to code information for three aspects of the healthcare encounter: a patient's reasons for contact, the healthcare practitioner's assessment of the diagnosis or problem and the process of care (decision, action or plans).

ICD-10: The International Classification of Diseases pro-vides a comprehensive definition of diseases, disorders, injuries, symptoms and the reason for the encounter, together with social factors and external causes. Descriptions are organised into standard groups, improving the retrieval and analysis of health information for evidence-based decision-making. ICD-11 is due to be released in 2022. ICD is the international standard for mortality and morbidity statistics.

Consider using the Irish Primary Care Research Network (IPCRN) tools in your software to capture likely patients with many of the diseases in the Chronic Disease Programme. Otherwise, search for medications specific to the disease such as inhaled steroids/bronchodilators for asthma and COPD or elevated blood results like HbA1C/ProBNP for diabetes and heart failure patients. If you aren't coding yet there is a lot of work involved in finding the patients with the listed diseases. It may be easier to start coding patients as they present, but it is essential that everyone in the sur-gery does it together and all use the correct codes. See also the 'how to' leaflets in the GPIT section of www.icgp.ie

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