COPD Coding Checker
COPD Coding Checker
In July 2025 Practices started to notice that certain patients were being invited for reviews for COPD, despite not appearing to have the condition on their record. These patients had also been added to the COPD register leading to a jump in register sizes. So, what had happened?
The problem lies in the nationally defined code lists managed by the clinical terminology teams at NHSE, and is not the fault of the clinical system suppliers - Optum (EMIS), TPP, Medicus.
Primary Care IT dug a little deeper and found that some codes had been added to the COPD_COD reference set - used by QOF to define the codes to include a patient on the register.
Data from the TRUD website revealed the change was made in v56.0.0 of the UK Primary Care Domain reference sets which was released on 30th June 2025. It takes at least a few weeks for these updates to be processed and implemented by the clinical system suppliers.
There were 3 codes added to COPD_COD in this release:
Code Term | SNOMED |
Chronic obstructive pulmonary disease annual review | 394703002 |
Chronic obstructive pulmonary disease follow up | 394702007 |
Chronic respiratory disease originating in perinatal period | 1287820006 |
The first 2 codes are clearly monitoring codes, which is not in keeping with many other disease registers. The third code is technically a diagnosis code, but may be ambiguous in its interpretation in the expected few cases it has been used.
Comparing the current COPD register size with the end of year QOF register size from 31st March may be a helpful indicator for how many patients are affected. A typical 10k list size Practice might ordinarily expect the register to increase by 4 or 5 patients in 6 months, whereas jumps of 10+ are more likely to be related to the review codes.
Update
The good news is that TRUD v57.0.0 was released on 4th September 2025 where the annual review and follow-up codes have been removed. However, even if system suppliers are asked to accelerate the removal, users may not notice a change until at least October.
Where might the incorrect codes have come from?
When Practices review their affected patients there may be a number of reasons, dating back years, with codes added by staff who no longer work at the Practice, or codes may have been added at a patient's previous Practice.
The most probable reasons are going to be:
- accidental coding arising during asthma reviews
- intentional use during reviews for patients with a respiratory condition (such as bronchiectasis), but for whom there are no dedicated monitoring codes
In your own Practice, look for patterns such as codes added by a particular user - can they be educated especially if still working; codes attached to documents - if that template is still in use consider if the template be altered.
What can practices do about it?
This is a difficult question to answer. Even though there has been confirmation that the COPD reference set will be revised, the seasonal timing means some steps will need to be addressed sooner.
This event is similar to the situation in late 2023 when a significant number of codes were added to the Learning Disability register. It took 6-8 weeks for the codes to be removed, even with the system suppliers being asked by NHSD to accelerate the fix, during which time patients were being incorrectly identified for reviews.
At this time of year affected patients may also be included in the recall for flu, or for a pneumococcal vaccination. From a CQRS standpoint, these vaccination programmes use different code reference sets labelled CRDATRISK2_COD and CRDATRISK1_COD, so patients recently added to the register due to the annual review or follow up codes will not be recognised. Primary Care IT's own resources align with CQRS to ensure payment.
As the code 'Chronic respiratory disease originating in perinatal period' is a diagnosis, it exists in all of these reference sets.
Re-coding records is never ideal or appropriate but may be one solution to the problem, particularly if the codes will remain in the reference set
Practices may also need to review their own searches and implement a change to exclude patients who only have the annual review or follow up codes. Fortunately, this is not too complicated in EMIS and TPP.
PCIT Resources to Help
Primary Care IT has built reports for EMIS Web and TPP SystmOne to help Practices identify patients who have been added to the COPD register on the basis of the annual review or follow up codes alone - no COPD or emphysema diagnoses. The reports can breakdown the number of codes found on each record, which we hope will help Practices to form a plan about how to address the coding.
The files are available to download for free from the Primary Care IT website.
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