Version 17 – May 2015
Integrated Care TH - Coding summary
Eligibility
AUA DES
2% top QAdm (practice level)
Code as:
13Zu = At risk of emergency
admission (optional code-it
may help you to quickly
identify the AUA DES eligible
patients)
Consent
Not applicable
Register - entry 8CV4 = AA care started
Register - exit
8CT2 = AA care ended
Register refusal
Patients can decline the crisis
plan but still be in the register
for other purposes such as tel
access
8CSB = AA CP agreed
8CMG3 = AA CP reviewed
8IAe1 = AA CP declined
CP document to be emailed
to Single Point of Access
Care Plan
Entry level
Top 4.1% to 6% QAdm
(borough) plus any patients
under the previous CC NIS
(Dementia/ HF/ Home
/Palliative / Discretionary
(HNGNQRF62) b4 20Aug13
consented by 31/03/14)
Level 1
Top 4% QAdm (borough) plus any
patients under the previous CC
NIS (Dementia/ HF/ Home
/Palliative / Discretionary
(HNGNQRF62) b4 20Aug13
consented by 31/03/14)
minus AUA DES patients
Level 2
Dementia/ HF/ Home /Palliative /
Discretionary (HNGNQRF62) b4
20Aug13 consented by 31/03/14
Code as:
Code as:
Code as:
‘eligible for IC pathway’
‘eligible for IC pathway’ (9NgzB) ‘eligible for IC pathway’ (9NgzB)*
(EMISNQEL6)*
*
Has the patient given consent to share data (93C0 code) and to enter the IC pathway? If yes, they can
enter the IC pathway.
8CMR = on IC pathway *** (if 8CMR = on IC pathway ***(if
As for Level 1 plus:
consented-93C0)
consented- 93C0)
EMISNQON5 (On frailty register)if
the patient agreed to enter Level 2
9Ngx = No longer on IC
9Ngx = No longer on IC pathway
‘Removed from frailty register’ =
pathway
EMISNQRE476
8IEq = IC pathway declined
8IEq = IC pathway declined
’Patient declined Inclusion in frailty
register (EMISNQPA350)
8CSB = AA CP agreed
8CMG3 = AA CP reviewed
CP document to be emailed to
Single Point of Access
1
As for Level 1 plus:
Level 2 Person-centred care plan
(8CM8)to be given to the patient
Palliative care document of
patients in their last days of life
(2JE) to be emailed to Single Point
of Access if appropriate
Version 17 – May 2015
Requirements
for payment
Requirements for payment 1
via NHS England based on
coded data:
8CV4 = AA care started
** Accountable GP (67DJ)
** Crisis Plan (8CSB)
Requirement for payment3 via
CCG based on coded data:
**‘eligible for IC pathway’
(EMISNQEL6)
**8CMR = on IC pathway
** Consent (93C0) (newly
consented in year 2015-16)
Based on coded data:
**‘eligible for IC pathway’ (9NgzB)
**8CMR = on IC pathway
** Accountable GP (67DJ)
** Crisis Plan(8CSB/8CMG3)
** Consent (93C0)
For PAM payment: patient
participation in two PAM
questionnaires and coding of
scores on EMIS (38Qo)
Template to
follow
Payment
amount
Integrated Care (& AUA) TH
Template Guide CEG
As specified in the AUA DES
document-Payment by NHS
England
Integrated Care (& AUA) TH
Template Guide CEG
Consent (93C0): Number of
newly consented patients X
£10. If patients were
consented in previous years,
no payment will be made.
As for Level 1 plus:
Based on coded data:
**EMISNQON5 (On frailty register)
**Care Coordinator (EMISQCA4)
**Patient-centred Care Plan
(8CM8) –This code reflects the
personalised care planning process
and not just the document. By
ticking this box, it means that a
meaningful personalised care
planning consultation has taken
place. 3
Integrated Care (& AUA) TH
Integrated Care (& AUA) TH
Template Guide CEG
Template Guide CEG
Crisis Plan(8CSB): Number of
Patient-centred Care Plan (8CM8):
patients x £90
Number of patients X £110
Accountable GP (67DJ): Number
of patients with newly entered
accountable GP X £5 (code must
have been entered in 2015-16).
If the patient had an allocated
named clinician in previous years,
no payment will be made.
Number of people with first PAM
scores [code 38Qo]within the
financial year x £5,
Number of people with second
PAM score at least 90 days after
first score, x £5 (CEG data)
Key: AUA: Avoiding Unplanned Admissions; IC: Integrated Care; CC: Coordinated Care; AA: Admission Avoidance; CP: Crisis Plan
2
Version 17 – May 2015
*Instructions on how to batch code these eligibility codes can be found in a separate document.
** = payment metric
*** You can retrospectively enter the code 8CMR (on IC pathway) by batch-coding all patients with the eligibility code 9NgzB who have been consented (i.e.
all patients with codes 9NgzB plus 93CO).
1. According the AUA DES spec, you will need to be able to demonstrate that the following took place: follow up within 3 days after emergency
admission or A&E discharge, same day telephone consultations and monthly reviews of the register & of unplanned admissions & A&E attendances.
2. According to the IC NIS, you will need to be able to demonstrate the following mandatory requirements: That the practice provides same day
telephone access to all patients under the IC NIS, MDTs take place, practices have evidence (minutes) of a minimum of 8/year practice-level
caseload meetings and attended a minimum of 2 out of 3 project stakeholder workshops. As part of the crisis plan the patient should be referred as
appropriate to: Rapid response & discharge support, RAID, Community Virtual ward.
3. According to the IC NIS Level 2 requirements, you will need to be able to demonstrate that the care planning process includes the following
wherever appropriate: Functional / Geriatric Assessment, medication review, palliative care assessment with appropriate visits every 2 weeks and
alert letters to OOH for patients in their last days of life, person-centred goal setting, care and support documentation, mobility and falls
assessment, depression and dementia screening etc.
3