Proposed OPCS-4 Sequencing Methodology – Impact on Patient Administration Systems

Overview

In November 2012 the Clinical Classifications Service (CCS) consulted on a preferred PYZ methodology for use in coding procedures (single or multiple) using the OPCS-4 classification, in order to provide uniformity of clinical coding. Introduction of a standard sequencing logic will allow a consistent presentation of all actions which take place during single or multiple interventions, and will enable the clinical coding professional to describe in full detail the actions of each separate procedure. Consistent application will help analysts to extract and interpret the data correctly.

The proposed methodology is as follows:

1. Record the code for the primary action/procedure from the body system chapters (Chapters A – T and V – W) or miscellaneous procedures and operations covering multiple systems (Chapter X).
2. Record the code(s) for the supplementary approach code and actions from Chapter Y Subsidiary Classification of Methods of Operation (if required*).
3. Record the relevant site code from Chapter Z Subsidiary Classification of Sites of Operation (if required*).
4. Record the code for the laterality of intervention/procedure from Chapter Z Subsidiary Classification of Sites of Operation (if required*).
5. Repeat the sequence for multiple subsequent procedures performed on the same body site (if required*).

This methodology (Action (P) - Approach (Y) - Site (Z)) is referred to as PYZ logic.

*Supplementary approach, site and laterality may be inherent in the code description

An alternative methodology which is still currently in use is was to assign a minimum number of codes, and in cases where multiple procedures were performed on the same body site, to only assign the site code once. This methodology (Action (P) – Action (P) – Approach (Y) – Site (Z)) is referred to as PPYZ logic.

Examples of both PYZ and PPYZ are shown below, showing how a 'laser excision of cystic hygroma from the neck and face' following the 'minimum code assignment' logic would be coded:

Why your views matter

Feedback from the previous consultation identified that a number of trusts might encounter problems in implementing the preferred PYZ methodology due to file space and/or field size limitations in their Patient Administration Systems (PAS) and the potential impact such changes may have on the workforce (for example, the additional time taken by coders to code each patient episode).

Given this feedback, the CCS would like to understand the anticipated impact(s) of making changes to PAS and the possible impact on the clinical coder workforce, so that, where possible, we can take these into account. If the outcome of this consultation supports the need for a new clinical coding standard, trusts will be given time to take the necessary steps to prepare for the change. We are not at this stage, making any recommendations: this is an exploratory consultation to establish the impact of PYZ implementation, should it go ahead.

The CCS wants to receive as much feedback as possible from users of OPCS-4 and OPCS-4 data, as it is important that we make implementation decisions based on a broad spectrum of views and opinions across the NHS and its partners.

What happens next

The information produced by this survey will be used by the CCS to determine the possible consequences and timing of adopting the proposed sequencing methodology, and to inform any future implementation timetable.