OPCS-4

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OPCS-4, or more formally OPCS Classification of Interventions and Procedures version 4, is the procedural classification used by clinical coders within National Health Service (NHS) hospitals of NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. It is based on the earlier Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (4th revision),[1] and retains the OPCS abbreviation from this now defunct publication.

OPCS-4 codifies operations, procedures and interventions performed during in-patient stays, day case surgery and some out-patient treatments in NHS hospitals. Though the code structure is different, as a code set, OPCS-4 is comparable to the American Medical Association's Current Procedural Terminology.

As a publication, OPCS-4 is split into two volumes; a tabular list (Volume I) and an alphabetical index (Volume II).[2] An electronic version is also available.[3] However, a number of supplementary publications are also used by coding staff.

History[edit]

The first NHS procedural classification was published in 1987, by the Office of Population Censuses and Surveys (OPCS) as the Classification of Surgical Operations. In 1992 the 4th revision was released as the OPCS Classification of Surgical Operations and Procedures (4th revision),[1] usually shorted to OPCS-4.2. Responsibility for the classifications used in the NHS, including OPCS-4, passed to the NHS Information Authority (NHS IA) when it formed in 1999.

By 2003, the NHS IA had realised OPCS-4.2 no longer accurately reflected many of the procedures being performed in the UK healthcare system. As a medium term measure, a project to replace OPCS-4 with a more robust method of procedure coding was proposed and partially developed. Rather than using a sequence of codes to capture activity, the new classification would have used a single alphanumeric code up to 15 characters long. When the NHS IA was superseded by NHS Connecting for Health (NHS CFH) in 2005, the project was placed on indefinite hold, and a program of annual revisions to OPCS-4 was implemented. Much of the development work for the suspended project was reused to produce the initial expansion and enhancement of OPCS-4.2 to OPCS-4.3. However, OPCS-4.2 remained the mandated method of procedural classification in the NHS setting until March 2006.[4]

Since the implementation of OPCS-4.3 in April 2006 there have been four further revisions to OPCS-4. Each becoming the mandated classification on 1 April in the year of publication.

OPCS-4 version mandated for use (financial year)[5]

  • Up to 31 March 2006 OPCS-4.2
  • 2006-7 OPCS-4.3
  • 2007-9 OPCS-4.4
  • 2009-11 OPCS-4.5
  • 2011-14 OPCS-4.6
  • 2014 OPCS-4.7 (until further notice)[4]

Whilst additions to OPCS-4 are reviewed on an annual basis, the long term plan is to replace OPCS-4 with SNOMED CT.[6]

On 31 March 2013 NHS CFH ceased to exist. Since 1 April 2013, responsibility for revision and maintenance of OPCS-4 has been with Health and Social Care Information Centre (HSCIC).

Code structure[edit]

OPCS-4 is an alphanumeric nomenclature, with a 4 character code system similar to that found in ICD-10. The differences being that OPCS-4 classifies procedures and interventions, rather than diagnoses, and that the chapters do not correlate (i.e. Chapter A of OPCS does not classify treatments for conditions in Chapter I of ICD-10).

The first character is always a letter. Second, third and fourth characters are always numbers. A . separates the third and fourth characters; for example

Syntax of an OPCS-4 code
1st character 2nd character 3rd character 4th character
A 0 1 .1

Chapter List[edit]

There are currently 24 chapters in Volume I of OPCS-4:

  • Chapter A - Nervous System
  • Chapter B - Endocrine System and Breast
  • Chapter C - Eye
  • Chapter D - Ear
  • Chapter E - Respiratory Tract
  • Chapter F - Mouth
  • Chapter G - Upper Digestive System
  • Chapter H - Lower Digestive System
  • Chapter J - Other Abdominal Organs, Principally Digestive
  • Chapter K - Heart
  • Chapter L - Arteries and Veins
  • Chapter M - Urinary
  • Chapter N - Male Genital Organs
  • Chapter P - Lower Female Genital Tract
  • Chapter Q - Upper Female Genital Tract
  • Chapter R - Female Genital Tract Associated with Pregnancy, Childbirth and the Puerperium
  • Chapter S - Skin
  • Chapter T - Soft Tissue
  • Chapter U - Diagnostic Imaging, Testing and Rehabilitation
  • Chapter V - Bones and Joints of Skull and Spine
  • Chapter W - Other Bones and Joints
  • Chapter X - Miscellaneous Operations
  • Chapter Y - Subsidiary Classification of Methods of Operation
  • Chapter Z - Subsidiary Classification of Sites of Operation

"Missing" chapters[edit]

I codes[edit]

There is currently no Chapter I. Nor are there any codes beginning with an "I".

O codes[edit]

Whilst there is no Chapter O, codes beginning with an "O" can be found in OPCS-4. These were added to chapters when all the available 3-character code blocks were exhausted, but further classifications were needed. They are also referred to as "overflow codes", and are located at the end of the related chapter. When indexing a procedure or intervention that is classified to an O code, the letter denoting the chapter the code is found in is given in parentheses after the code.

Copyright[edit]

As an NHS publication, OPCS-4 is covered by Crown Copyright.

Supplementary publications[edit]

There are a number of publications that supplement OPCS-4.

Instruction Manual[edit]

The OPCS-4.6 Clinical Coding Instruction Manual is a reference book on how to use OPCS-4 to national standards. It is initially supplied to novice coders who attend a foundation course run by an Approved Trainer. Whilst each revision to OPCS-4 sees the issue of a new manual, updates are issued electronically, and the onus is on coders to update them by hand.

With the introduction of OPCS-4.7, and the move of maintenance responsibility to HSCIC, the instruction manual has been renamed to National Clinical Coding Standards OPCS-4.

The Coding Clinic[edit]

The Coding Clinic publication is how minor changes and coding advice for both ICD-10 and OPCS-4 are disseminated through the UK clinical coding community. Initially issued as a printed newsletter, in 2012 the format was switched to a single, compendium-like electronic publication.

High Cost Drugs List[edit]

Maintained by the Department of Health's (DH) Payment by Results team; the High Cost Drugs List is a catalogue of drugs licensed for use in the NHS that are excluded from the Payment by Results (PbR) tariff.

Issued annually - even in years with no revision to OPCS-4 - the list consists of the generic names of certain drugs next to the relevant OPCS-4 code. The guidance section of the list states that it is down to the clinical staff to use the generic instead of brand names.

Chemotherapy Regimens List[edit]

The Chemotherapy Regimens List, also issued by the DH Payment by Results team, is for the coding of administration of antineoplastic drugs. Organised alphabetically, the list contains adult and paediatric chemotherapy regimens used in the NHS. Drug trials are excluded as they are usually financed by the trial's commissioner, for example a pharmaceutical company or cancer charity.

The National Clinical Coding Standards OPCS-4 and both DH lists are issued via Terminology Reference Data Update Distribution Service (TRUD)[1]

See also[edit]

References[edit]

External links[edit]