Changes to the QOF business rules and the introduction of SNOMED-CT coding have resulted in some changes to the way in which cervical smears are coded. This post explains the changes and what action you may wish to take as a result.
The following information on cervical smear codes was recently shared by NHS England:
The following information on cervical smear codes was recently shared by NHS England:
Re: QOF 2018/19 – Cervical Screening
This message is for information relating to QOF 2018/19.
It has been brought to our attention that some practices might be using Read and CTV3 code 685.. ‘Cervical neoplasia screening’ as an administrative code or problem heading to manage cervical screening recalls.
This Read/CTV3 code’ 685..’ was not included in the code cluster SMEAR _COD for QOFv38 (Payment QOF2017-18).
The Read and CTV3 code 685.. ‘Cervical neoplasia screening’ is in the preventative procedures chapter and has been mapped to the SNOMED term 171149006 ‘Screening for malignant neoplasm of cervix’ which is in the cancer screening hierarchy in SNOMED. There are some other Read and CTV3 codes that also map to SNOMED code171149006. The table below shows Read/CTV3 codes that are mapped to SNOMED code 171149006 ‘Screening for malignant neoplasm of cervix’.
We have consulted with our terminology team and clinical advisors and asked for the mapping to be reviewed, and it was agreed that these maps are appropriate. The methodology to undertake the mapping from Read and CTV3 to SNOMED, plus an extensive quality assurance process, has been overseen by a number of national GP clinical leads and terminology experts and validated by the Joint GP IT Committee. The mapping tables have been signed off as clinically safe for the transition of historical data.
On this basis 171149006 ‘Screening for malignant neoplasm of cervix’’ has been included in the cluster SMEAR_COD for QOF v41 (Payment QOF 2018-19). The effect of this is that records with 685.. ‘Cervical neoplasia screening’ will now be reported for QOF v41. If the QOF cluster is used to support cervical smear recall then patients who have a record where 685.. has been used as an administrative code may appear to have had a smear and could be missed from smear recall.
We would therefore request that practices check for this code in their records so that if they are using it for administrative purposes, rather than to show the smear has taken place, then they will need to update their records for the end of year. The SNOMED code 714971000000104 | Cervical smear screening administration | which is a ‘heading’ code could be used instead.
Whilst the QMasters Cervical Smear template does not use the '685' code, it does use some of the child codes, so we have chosen to undertake a review of all of the 685.. codes used in our smear template.
The detailed breakdown of the findings are shown in the table below: all except 2 of the codes are legitimate for use under the current (v39) business rules and all of them are legitimate for use in the v41 business rules, on which end of year payment will be based.
The detailed breakdown of the findings are shown in the table below: all except 2 of the codes are legitimate for use under the current (v39) business rules and all of them are legitimate for use in the v41 business rules, on which end of year payment will be based.
What does this mean for QMasters customers?
For users of QMasters templates, it means that entries of the codes 685L or 6856 via the Cervical Smear template may not be recognised by the current v39 release of the QOF searches so may show patients still needing a smear when they have in fact declined (685L) or had a smear (6856).
These codes are, however, still appropriate to use under the v41 rules which should be applied in February. These will be the rules used for payment at QOF year-end. We do not therefore recommend any change in practice.
For users of QMasters templates, it means that entries of the codes 685L or 6856 via the Cervical Smear template may not be recognised by the current v39 release of the QOF searches so may show patients still needing a smear when they have in fact declined (685L) or had a smear (6856).
These codes are, however, still appropriate to use under the v41 rules which should be applied in February. These will be the rules used for payment at QOF year-end. We do not therefore recommend any change in practice.
What does this mean for users who are not QMasters customers?
If you use your own templates, or enter codes manually, you need to ensure your practice has not been using the 685 code (cervical neoplasia screening) as an administrative code, as it may appear that these patients have actually had a smear when they have not, and hence be removed from the recall lists.
If you have been using a 685 code in this way, you may want to run a search for all patients with a 685 code without another, definite, smear procedure code and ensure there are not a cohort who have been inappropriately removed from the recall list.
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