Document filename: Survey Results NICIP to OPCS-4 mapping table
Directorate / Programme
Architecture,Standards,
Innovation
Document Reference
Project
Clinical
Terminology
TBC
Project Manager
[Manager]
Status
Approved
Owner
Ian Arrowsmith
Version
1.0
Author
Ian Arrowsmith
Version issue date
30/01/2015
Results of survey on usage of national
interim clinical imaging procedures to
OPCS-4 mapping table
Copyright ©2013 Health and Social Care Information Centre
Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
30/01/2015
Document Management
Revision History
Version
0.1
0.2
0.3
0.4
Date
14th April 2014
16th January
2015
20th January
2015
30th January
2015
Summary of Changes
First draft for comment
Amended following comment from reviewers
Amended following further review
Updated to reflect approval status
Reviewers
This document must be reviewed by the following people:
Reviewer name
Elaine Wooler
Title / Responsibility
Advanced Clinical
Terminology Specialist
Date
16th January
2015
Version
Karim Nashar
Clinical Terminology
Specialist
9th January
2015
0.2
Ian Spiers
Clinical Terminology
Specialist
16th January
2015
0.2
Genevieve Cogman
Classification Specialist
6th January
2015
0.1
Clinical Imaging Procedures
Management Group
20th May
2014
0.1
UKTC Management team
21st January
2015
0.3
0.2
Approved by
This document must be approved by the following people:
Name
Signature
Title
UKTC Management Team
Date
21st January
2015
Version
1.0
Glossary of Terms
Term / Abbreviation
CIMG
What it stands for
Clinical Imaging Procedures Management Group
HSCIC
Health and Social Care Information Centre
NICIP
National Interim Clinical Imaging Procedures
SNOMED CT
Systematized Nomenclature of Medicine Clinical Terms
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Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
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IHTSDO
International Health Terminology Standards Development Organisation
UKTC
UK Terminology Centre
RIS
Radiology Information System
PACS
Picture Archiving and Communication System
Contact Information
This document is produced by:
Address:
The UK Terminology Centre (UKTC)
Princes Exchange
Leeds
LS1 4HY
Telephone:
0300 30 34 777
Email:
information.standards@hscic.gov.uk
Internet:
http://systems.hscic.gov.uk/data/uktc
Document Control:
The controlled copy of this document is maintained in the HSCIC corporate network. Any
copies of this document held outside of that area, in whatever format (e.g. paper, email
attachment), are considered to have passed out of control and should be checked for
currency and validity.
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Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
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Contents
1
Purpose of document
5
2
Audience
5
3
Scope
5
4
Background
5
5
Methodology
7
6
Results
7
6.1
Question - What is your job title?
7
6.2
Question - What is your organisation?
7
6.3
Question - Who is your Radiology Information System (RIS) Provider?
8
6.4
Question - Who is your PACS System Provider?
8
6.5 Question - For any other system that uses NICIP or SNOMED CT Code Set, please
explain the primary function of this system
8
6.6
Question - Did you know of the existence of a NICIP to OPCS-4 mapping table?
6.7 Question - Does your trust use the NICIP to OPCS-4 mapping table for assigning
the imaging procedure instance to a Healthcare Resource Group?
9
9
6.8 Question - Is the coding for PbR carried out in the clinical imaging department or by
the clinical coding department of the trust?
10
6.9 Question - Have you found any issues with the NICIP to OPCS-4 mapping table for
assigning the imaging procedure instance to specific OPCS-4 codes (e.g. 'missing'
contrast code for angiography, disagreement over choice of imaging or site code,
etcetera)?
10
6.10
Other feedback
11
7
Discussion
12
8
Conclusion and recommendations
13
9
Appendix 1 – questionnaire
14
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Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
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1 Purpose of document
The purpose of this document is to describe the results of a survey to inform future
development of the National Interim Clinical Imaging Procedures (NICIP) to OPCS-4
mapping table and inform the Payment by Results (PbR) data in the field of Clinical Imaging.
2 Audience
This document is written for all stakeholders interested in the development and use of the
NICIP to OPCS-4 mapping table. This will include those parties responsible for maintenance
of the mapping table and supporting guidance at the Health and Social Care Information
Centre (HSCIC), those responsible for policy development at the Department of Health and
NHS England, and those that use the table to create their national returns, as well as
professional bodies, suppliers and other interested parties.
3 Scope
This consultation was only focussed on the use of the NICIP to OPCS-4 mapping table and
its use to support PbR processes. It was intended to inform the decision making process
regarding plans to adjust the mapping table to meet user requirements or to withdraw the
mapping table
Recommendations from the survey will be used by the HSCIC to inform decisions on
potential further development of the mapping table.
4 Background
The National Interim Clinical Imaging Procedures code set have been published by the
UKTC since 2007 and were approved by the Information Standards Board (ISB) for Health
and Social care as an NHS information Standard in December 2009. The ISB scope of
approval for use of the standard was “to provide a standard terminology for describing
clinical imaging procedures to facilitate identification of images undertaken in an imaging
examination, and for the communication of clinical information associated with the identified
procedures such as imaging service requests, patient imaging reports, statistical measures
of activity and to assist workflow aspects of the business of imaging departments such as
resource scheduling.” (DSCN 27/2009 - http://www.isb.nhs.uk/library/standard/125).
For further information on the NICIP codes see:
http://systems.hscic.gov.uk/data/uktc/imaging
To download the code set visit: http://www.uktcregistration.nss.cfh.nhs.uk/trud3
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It was apparent that an extension to this operational code set could potentially assist with the
collection of activity data and other secondary uses information such as that required for the
KH12 radiation monitoring return and the data required for Payment by Results (now the
2014/15 National Tariff Payment System) in a standardised and nationally consistent
manner.
The Clinical Imaging procedures Management Group (CIMG), the editorial authority behind
the National Interim Clinical Imaging procedures code set, recommended the development of
a simple mapping table to support the derivation of consistent HRG assignment for patient
activity undertaken in clinical imaging to support consistent national standardised reporting.
The NICIP codes (or their SNOMED CT equivalent concepts) are used throughout the NHS
in all clinical imaging departments in England and, by virtue of their close alignment with
SNOMED CT, have an assigned mapping to OPCS-4.
Before the development of the mapping table, evidence from a sample of Trusts in the North
West found significant variation between Trusts in the local mapping of imaging procedures
to OPCS-4 codes and HRGs. Faced with this evidence the CIMG requested that the team
within the HSCIC develop a standard mapping table to make the process less subjective.
This table has been distributed as a ‘test’ product since October 2009 with a covering note
asking for feedback. Since then, some issues have been notified and amendments made to
the table though there are also a few more fundamental issues which need resolution before
the table can be considered to be fully quality assured and ready for formal approval.
More recently the Department of Health has developed guidance for PbR which ‘requires’
Trusts to use this table to assign OPCS-4 codes in order to assign HRGs,
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214902/PbRGuidance-2013-14.pdf
however, some of the aforementioned issues with the design and content of the table remain
unresolved.
It has therefore become necessary to determine whether this product either has to be
adjusted and confirmed as fit for purpose for Payment by Results (PbR) guidance (when
corrected appropriately) or whether the product should actually be withdrawn.
The UKTC maintain a Product Development Lifecycle Policy which clearly explains how new
and existing products are managed through their entire development from inception to
retirement. The policy describes the approach and underpinning processes that allow
products to be introduced and/or retired responsibly so that expectations can be set
realistically and product statuses are clearly understood. The status values are:
1.
2.
3.
4.
5.
In Development
Technology Preview
Draft for Trial Use
Supported Product
Legacy Product
Decisions to progress a product from one status to another shall be the responsibility of the
relevant editorial or governance authority who will need to be provided with sufficient
evidence of utility and demand in the stakeholder community.
This survey was therefore commissioned to assess where this table is being used currently,
how effective and useful it is and whether any additional enhancements are required.
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5 Methodology
An on-line questionnaire was hosted on the HSCIC consultations portal at
https://consultations.infostandards.org from 17th February to 17th March 2014.
Stakeholders on UKTC and ISB distribution lists were notified about the consultation by
email.
The questions were developed within the HSCIC functions responsible for the maintenance
of the mapping table and were based upon areas highlighted in previous feedback,
particularly that provided by experts at The Royal Marsden Hospital.
There was no pilot of the questionnaire which can be found in appendix 1.
The responses were collated and presented for review in this document.
6 Results
There were 21 responses to the consultation in total though not all questions were answered
by every respondent. Names and email addresses were taken so that the results of the
survey could be fed back directly to answer any queries raised.
Questions were answered as follows
6.1 Question - What is your job title?
There were 20 responses to this question and a wide variety of roles reported so the results
were categorized into either a radiology department role or a role in the
informatics/coding/finance departments, for ease of analysis.
Role category
Radiology
Informatics/coding/finance
Not stated/known/applicable
Number of respondents
7
13
1
The full list of roles is:
Head of Information and Income, RIS Admin, Radiology IT Manager, Finance Manager, Information Design
Consultant (Casemix), Clinical Coding Manager, Data Quality Consultant, Income and Costing manager,
Payment by Results Project Manager, System Analyst/Developer, Divisional Information Manager, PACS & RIS
Manager, Clinical Coding Manager, RIS/PACS Admin, SQL Systems Developer, Data Warehouse
Administration, Diagnostics Systems & Performance Manager, Information Services Manager, Radiographer,
Chief Radiographer
6.2 Question - What is your organisation?
There were 19 answers to this question. All but one response were from NHS Trusts, the
other was from the HSCIC.
Organisation type
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Number of respondents
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Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
NHS Trust
Other
Not stated/known/applicable
30/01/2015
18
1
2
The full list of organisations is as follows:
Dartford and Gravesham NHS Trust, Southend University Hospital Trust, Maidstone & Tunbridge Wells NHS
Trust, HSCIC, ‘NHS Acute Trust’, Heatherwood & Wexham Park Foundation Trust, Homerton University
foundation hospital trust, Doncaster & Bassetlaw Hospitals NHS Foundation Trust, SWBH NHS Trust, The
Dudley Group NHS FT, Central Manchester University Hospitals NHS Foundation Trust, BSUH, ESHT (RXC),
North Bristol Trust, The Hillingdon Hospitals Foundation Trust, United Lincolnshire Hospitals NHS Trust,
University Hospital Southampton NHS FT, Barts Health (Newham), Worcestershire acute NHS Trust
6.3 Question - Who is your Radiology Information System (RIS) Provider?
There were 19 responses to this question, though some respondees reported for multiple
sites so had more than one RIS supplier resulting in a total of 8 different RIS suppliers.
RIS Supplier
Zillion
Healthcare Software Solutions (HSS)
Philips
GE
McKesson
Radwise
Radnet
Cerner
Not stated/known/applicable
Number of respondents
1
11
2
1
1
1
1
1
3
6.4 Question - Who is your PACS System Provider?
There were 20 responses to this question, though many did not know who their PACS
system supplier was and one reported for multiple (two) sites.
PACS Supplier
GE
Sectra
Agfa
Kodak
Synapse
Philips
Fuji
Insignia
Intellispace
Not stated/known/applicable
Number of respondents
2
3
3
1
1
1
1
1
1
8
6.5 Question - For any other system that uses NICIP or SNOMED CT Code
Set, please explain the primary function of this system
There were 6 responses to this question, with one respondent detailing two systems.
System Supplier
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Nature of system
Number of instances
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Results of survey on usage of national interim clinical imaging procedures to OPCS-4 mapping table V1.0
Phillips Tomcat
Clinical Measurement (Cardio
diagnostics)
1
Semahelix
Patient Administration System
1
CVIS
Cardiovascular imaging
1
Trust Data warehouse (inhouse)
Data aggregation and reporting
McKesson
Patient Administration System
1
iPM
Electronic ordering and reporting
1
iReporter - Renaissance
Data Warehousing and Reporting
1
30/01/2015
1
6.6 Question - Did you know of the existence of a NICIP to OPCS-4 mapping
table?
There were 21 responses to this question.
Aware of NICIP to OPCS-4
mapping table
Number of respondents
Yes
No
21
0
Some respondents took the opportunity to add comments as follows:
Download from TRUD every six months
Would like to have applied the OPCS codes, but could never work out how. I did try several times
contacting the helpdesk, but despite their suggestions I could not find a document telling me how the
OPCS and HRG codes were linked. Why not a simple mapping to the NICIP codes release??
Helped draft the PbR guidance. Now work in the Casemix team in the HSCIC in developing HRGs. Use
the mapping to help clinicans, and others, understand the content of HRGs (by using the
NICIP/SNOMED to OPCS and then OPCS to HRG mappings) as well as for analysis of the DID.
But I didn't know there was a regular update.
I have vaguely seen and heard of it but not aware of what it is or what its purpose is.
The trust use this when implementing outpatient unbundled radiology
6.7 Question - Does your trust use the NICIP to OPCS-4 mapping table for
assigning the imaging procedure instance to a Healthcare Resource
Group?
There were 21 responses to this question.
Use NICIP to OPCS-4 mapping
table for HRG assignment
Number of respondents
Yes
No
Not applicable
18
2
1
Some respondents took the opportunity to add comments as follows:
Yes, used as the starting point but mapping modified after consultation with Clinical Coding.
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30/01/2015
Not sure - I believe finance think they have managed to apply some codes, but are either unwilling or
unable to share how they have done this.
Local HRG mapping tables used.
This is used for Reference Costs and also in year for SLR and PbR details
But we used the version we could find at the time the PbR changes were introduced (for April 13) and
have updated it manually after that
2013/14 Local payment - no
2014/15 Rebasing - yes
2014/15 Local payment – more than likely
This mapping table is incredibly valuable to us. Before its existence a multi-disciplinary team had to sit
down and manually create/review these mappings, which was very time consuming and very inconsistent
with neighbouring trusts
Very difficult as no national lookup of NICIP to HRG exists
But I believe it took a great deal of skill to interpret what the eventual HRG group would be for pBr. Some
of the matches did not work either e.g. CABAO apparently worked out to be RA08Z (no contrast) but it
always has contrast so mapped to RA09Z
6.8 Question - Is the coding for PbR carried out in the clinical imaging
department or by the clinical coding department of the trust?
There were 21 responses to this question.
Where NICIP to OPCS-4
mapping table used
Number of respondents
Imaging department
Clinical coding department
Not stated/known/applicable
10
8
3
Several respondents provided further comments to this question as follows:
Bit of both, Imaging select NICIP and the mapping plus input from coding produces OPCS.
Data quality issues around imaging use of NICIP - for example coding multiple exams separately
when there is a single NICIP code to cover both images.
(e.g. codifying an MRI Spine as four separate tests)
PBR values have been set on the basis of the number of parts/contrast use/etc, but I have not
found any way of mapping for example interventional codes
Currently it is the Information and Finance department doing the links between the imaging exam
code and the OPCS 4 codes via the mapping table.
MAINTENANCE OF DI EXAMINATION CODES - RADIOGRAPHER
MAPPING OF NON-ADMITTED CARE CLINICAL CODING/HRGS - INFORMATION SERVICES
CLINICAL CODING OF ADMITTED PATIENT CARE CLINICAL IMAGING - CLINICAL CODING
DEPARTMENT
Imaging assign an NICIP code, which is then translated for grouping.
Really niether, we have a look-up mapping table in the data warehouse
NICIP codes are added to CRIS within the Radiology department and the national published
mapping is relied upon in accordance with PbR Guidance to produce OPCS codes which are
grouped to HRG4.
We use a spare field in CRIS to add in the HRG against the Exam code. However what would be
really helpful would be for the NCIP data set to include the HRG group against the exam code
rather than just providing the mapping data table
6.9 Question - Have you found any issues with the NICIP to OPCS-4 mapping
table for assigning the imaging procedure instance to specific OPCS-4
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codes (e.g. 'missing' contrast code for angiography, disagreement over
choice of imaging or site code, etcetera)?
There were 21 responses to this question
Encountered issues with NICIP
to OPCS-4 mapping table
Number of respondents
Yes
No
12
9
Several respondents provided further comments to this question as follows:
Nuclear Medicine is poorly supported in OPCS and we have manually adjust the mapping of NICIP to OPCS
where an unbundled HRG is not produced because of the mapping to .9 non-specific code. Many site codes
are absent.
PBR values have been set on the basis of the number of parts/contrast use/etc, but I have not found any way
of mapping for example interventional codes
We have taken the table as gospel and manually matched data. Our problems arise from the source system
not fully using national codes and so the mapping does not flow completely.
I have raised a specific issue regarding dopamine transporter studies (794568)
Initially there we're a couple of OPCS codes incorrect, but these have since been amended, not aware of any
other issues.
We have found a lot of mappings are missing, but then we didn't know there was an updated file
My only use of these codes would be ensuring that diagnostics tests are assigned to the right HRG during the
reference costing process
FURTHER WORK IS REQUIRE IN YEAR TO FURTHER TEST AND REFINE CODING
WE HAVE LOCAL DI EXAM CODES THAT REQUIRE LOCAL INTERPRETATION/BUSINESS RULES
WE FOUND WE STILL USED RETIRED DI EXAM CODES DURING 2014/15 ROAD TEST
WE ARE ABOUT TO GO TO CONSULTATION WITH CLINICAL CODING MANAGER REGARDING
MAPPINGS
Incorrect code assignment for Portal Vein Sampling
Not all NICIP codes have an OPCS-4 equivalent
Does not cover all areas with required granularity
Any local issues of this nature have been overcome by seeking local coding advice and adding to the TRUD
table as we have done with any locally used pseudo NICIP codes.
Occasional incorrect code identified on DID, difficult for radiology to access this data, as controlled by
Business Intelligence Unit
But I believe it took a great deal of skill to interpret what the eventual HRG group would be for pBr. Some of
the matches did not work either e.g. CABAO apparently worked out to be RA08Z (no contrast) but it always
has contrast so mapped to RA09Z
Of those that had encountered issues, 7 were reported by organisations where the table was
used by the imaging department (70%) and 4 were reported by organisations where the
table was used by the clinical coding department.
6.10 Other feedback
Respondents were encouraged to comment on any other aspects of the use of the NICIP to
OPCS-4 mapping table not already covered in the survey. The following are the additional
comments:
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OPCS needs improving in tandem to improvements to NICIP and the mapping between the two. Clear
guidance on how to deal with multiple scans at one attendance and the need for radiology staff to use the
fewest number of NICIP codes to accurately describe the work that has taken place.
Why not a direct mapping released with the NICIP codes?
Happy to be involved in any work/queries or whatever from a HRG design perspective if needs be
THIS SUBJECT IS HIGH MY AGENDA AND I WOULD WELCOME ANY OPPORTUNITY TO BE INVOLVED
IN ANY WAY. PLEASE DO NOT HESITATE TO CONTACT ME ON THE EMAIL ADDRESS PROVIDED
Clinical Coding use it as a guide only.
However it can be a very busy spreadsheet.
If it was easier to read it may be used more.
All NICIP codes should have an OPCS-4 equivalent
A simplified mapping table would be useful without the historic mapping
The process to add codes needed was too long winded
We support the idea that there be a standard mapping table to make the process less subjective in terms of
PbR process and commissioner challenge between Providers.
Please include the HRG group against the exam code in the NCIP table
7 Discussion
Though the sample size of respondents is not large, it is possible to interpret some important
trends and issues from the survey results.
The indications are that the mapping table is widely used but that 11 out of 18 of the users
have encountered issues in using it.
Conversely there are also some users who have not encountered any issues, though it is not
clear from this simple survey whether it is being used in the same way in every organisation
and it may be that the issues have just not yet been detected.
Some of the issues reported are regarding perceived shortcomings in OPCS-4 (eg lack of
codes for nuclear medicine) or the lack of understanding of coding conventions by imaging
staff. This survey and prior experience suggests there is a cultural difference between the
perspective of those in the imaging department with those in the coding department. For
instance in the imaging department there would be an understanding that an angiogram
would need a supplementary code assigned (not currently incorporated in the table design)
which would be described as an issue by that type of user. Equally the expert coder, working
in isolation from the imaging department would never know it needed the supplementary
codes and not report this as an issue.
Some respondents called for a direct NICIP to HRG mapping table, for which there have
been requests before from other users (not participating in the survey). The expert advice is
that it is important that the OPCS-4 codes are identified accurately and comprehensively for
the appropriate HRG to be assigned using the grouper software.
The primary reasons for the production of the mapping table was to assist those responsible
for providing the mandated national returns and to improve the level of consistency between
them. Those organisations which are applying considerable local effort to enhance the
nationally prepared files are obviously making it more usable for their local circumstances
but also potentially decreasing the consistency of the returns.
A balance is needed to ensure as much as possible can be done to the national product to
minimise the amount of local tailoring. Therefore where common issues are identified then a
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decision has to be made on whether to adapt the national table accordingly, issue more
comprehensive guidance or leave users to their own devices.
The CIMG suggested it would be reasonable to address some of the shortcomings rather than
withdraw the mapping table
.
8 Conclusion and recommendations
There is significant evidence that this mapping table is of use to the intended target
community and that it should be progressed to a supported product when advised by the
CIMG.
It will be important for the UKTC to ensure all build processes are robust and fit for purpose
to ensure that adequate Quality checks are in place and that tools are efficient and reliable.
There are also a number of potential enhancements that could be made to the content of the
table as evidenced by this survey such as new OPCS-4 codes for nuclear medicine and the
addition of contrast codes to the table for those procedures which are known to always utilise
contrast.
Implementation guidance should be enhanced significantly with use cases described so that
patterns are more easily assigned the correct OPCS-4 code or codes wherever the process
takes place (with a recommendation that coding expertise and imaging knowledge are used
jointly).
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9 Appendix 1 – questionnaire
Name
Position
Email address
Organisation
Radiology Information System provider
PACS system provider
Any other system that uses NICIP or SNOMED CT code set please explain the primary function of this system
(please enter multiple if necessary)
System 1
Primary Function
System 2
Primary Function
System 3
Primary Function
Did you know of the existence of a NICIP to OPCS-4 mapping table
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Yes
30/01/2015
No
Comment
Does your Trust use the NICIP to OPCS-4 mapping table for assigning the imaging procedure instance to a
Healthcare Resource Group
Yes
No
Comment
Is the coding for PbR carried out in the clinical imaging department or by the clinical coding function of the
Trust
Imaging
Coding Department
Comment
Have you found any issues with the NICIP to OPCS-4 mapping table for assigning the imaging procedure
instance to specific OPCS-4 codes (eg ‘missing’ contrast code for angiography, disagreement over choice of
imaging or site code, etcetera)
Yes
No
If yes, please elaborate
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Please provide any other feedback you wish to provide on any related item in the box below
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