Clinical Coding Query Mechanism

If you are a clinical coding professional and you have a query, you must follow all of the steps below.

Please be aware that we will only accept queries that are within scope of the Product Support helpdesk.

If you are a non-coding professional thinking about submitting a coding or classification query, please read the query guidance for non-coding professionals

  • Consult the NICE Interventional Procedure Guidance (IPG). If your issue relates to the coding of a procedure, check the published IPGs. NB: ensure that the technical guidance description of the procedure matches the procedure you are coding before applying the recommended codes.
  • Consult the NHS Digital SNOMED CT Browser to check for Classifications Maps to ICD-10 and OPCS-4 if a condition or procedure is not available in the Alphabetical Index. See also the presentation providing an overview of SNOMED CT for clinical coders which includes information on the Browser, how to search and the classification maps.
  • Consult the ICD-11 Coding Tool and Browser if you are unable to locate a condition using the ICD-10 Alphabetical Index. The ICD-11 Coding Tool and Browser may indicate where the condition is classified to in ICD-11 and may be transferrable to a code or category in ICD-10.
  • Use internet research to help you learn more about the diagnosis or procedure. The database of useful links may be of assistance.
  • If your query relates to Healthcare Resource Groups (HRG's) check the information on the Healthcare Resource Groups (HRG) Related Resources page which contains resources specifically related to those aspects of clinical coding that we know are affected by HRG's. If this doesn't answer your query please direct it to the National Casemix Office at enquiries@nhsdigital.nhs.uk.
  • If you work in Northern Ireland, Wales or Scotland, please contact your local provider for coding query support:  
  • Discuss the issues with your coding and clinical colleagues and utilise the Clinical Coding Manager’s Workspace when required. Note: this is a closed workspace specifically for registered Clinical Coding Managers. If you are a Coding Manager and would like to join the workspace, please register via Delen.
  • Seek advice from clinicians about the condition/procedure, or where there is any uncertainty or discrepancy in the medical record ask them to clarify. Explain what the coding issue is and how this is or could be classified. Clinicians may not be familiar with the structure of ICD-10 and OPCS-4 so use your classification knowledge to explain this to them and guide them to the areas of the classification that you think are the most appropriate. We do not expect clinicians to select the code they think is correct but to rather offer advice; for example, they may have used different terminology and may recognize the alternative terms used in the classification.
Scope of the Clinical Classifications Product Support Helpdesk 

There are instances where the clinical coding professional with access to the medical record and responsible consultant, up to date knowledge of the classifications, coding principles and national clinical coding standards is best placed to apply their expertise to assign an appropriate classification code without referring to the helpdesk.

Queries within scope of the helpdesk Queries out of scope of the helpdesk

The helpdesk will address queries that may require national standards or guidance to improve the consistency and application of the classifications, rules and conventions. These include:

  • Proposals for new national coding standards
  • Coding standards that are ambiguous
  • Coding standards that need updating
  • Coding standards / information are incorrect
  • New procedures undertaken / additional index trails which may lead to a submission to the OPCS-4 Request Submission Portal

Queries out of scope of the helpdesk which can be resolved locally include:

  • Coding queries that can be resolved at source through discussions with the responsible consultant to understand the diagnosis or procedure recorded in the medical record
  • Unique / complex procedures where no national clinical coding standards exist but the rules and conventions of the classification can be applied to assign an appropriate subcategory code
  • Where no specific index trail or unique subcategory exist, research can be used to locate an appropriate code in the Alphabetical Index, as long as any uncertainty following this process is clarified with the resources available or the responsible consultant in order to assign the final subcategory code from the Tabular List

Application of a Coding Standard

It’s important to ensure our products are fit for purpose so please continue to submit queries where there is ambiguity around a coding standard or where advice is required in the correct application of a coding standard.

Notification of errors in our products (including our Query Resolution Database)

We are committed to providing high quality information so if you suspect that we’ve made an error in any of our publications, please submit these in the usual way.

Procedure guidance based on individual patient's (complex) procedure notes

Resolutions to specific queries that involve the assignment of OPCS-4 codes for individual patient’s procedure notes are not considered transferrable so won’t appear on the Query Resolution Database. Consequently these are not helpful to the wider coding service.

When we provide resolutions for these types of queries, the code assignment is based on consensus agreement as it’s often the case that there’s no ‘right or wrong’ answer. Notably, such responses are recommendations only.

In these instances, we recommend that you liaise with the responsible consultant, discuss with neighbouring trusts and with Coding Managers nationwide via the Clinical Coding Managers Workspace on Delen. Note: this is a closed workspace specifically for registered Clinical Coding Managers. If you are a Coding Manager and would like to join the workspace, please register via Delen.

Definition of a diagnosis or procedure

Queries requesting a definition of a diagnosis / procedure should be resolved through your own research, either by discussion with the clinicians at your trust or internet research. Information may also be available in OPCS-4.9 Supplementary Information.

Advice regarding the assignment of an ICD-10 or OPCS-4 code, where no index trail or unique subcategory code exists

  • In instances where no specific index trail or unique subcategory code exists, we may recommend a code or suggest that this should be agreed locally.
  • Queries of this nature rely on our own research to identify the most appropriate category that the condition or procedure should be classified to. We utilise many of the resources that are openly available, and we base our recommendations on these findings.
  • It isn’t possible to reliably extract data where no dedicated subcategory code exists, because the ‘recommended’ code wouldn’t be limited to that particular diagnosis/procedure.
  • In these instances, follow the steps in the Clinical Coding Query Mechanism and utilise the following approved resources:
Resource Description

ICD-11 Browser

ICD-11 Coding Tool

ICD-11 Maintenance Platform

ICD-11 Overview

ICD-11 is now considered stable and may be used to compare where new and existing conditions are classified to.

If you are unable to locate a condition using the ICD-10 Alphabetical Index, the ICD-11 Coding Tool and Browser may indicate where the condition is classified to in ICD-11 and may be transferrable to a code or category in ICD-10.

Where there is a map to ICD-10 this will be highlighted in the ICD-11 Maintenance Platform as a green box in the top right hand corner of the pane displaying the relevant ICD-11 code.

NHS Digital SNOMED CT Browser

Using the UK Classification Maps in the SNOMED CT Browser

The NHS Digital SNOMED CT Browser contains Classifications Maps to ICD-10 and OPCS-4. If a condition or procedure is not available in the Alphabetical Index, the Classifications Maps may be used as an aid.

If you are unfamiliar with using the SNOMED CT Browser, please consult the article ‘Using the UK classification maps in the SNOMED CT Bowser’.

NICE Interventional Procedure Guidance (IPG)

Interventional Procedure Guidance published on the NICE website is developed in collaboration with the Terminology and Classification Delivery Service.

NICE IPG may be used if the OPCS-4 Alphabetical Index does not contain a suitable index trail.

Orphanet Journal of Rare Diseases

Orphanet Journal of Rare Diseases is an online reference source of information on rare diseases. Its nomenclature is aligned with other classifications and terminologies such as ICD-10 and SNOMED CT. Orphanet may be used when a rare diseases such as syndromes cannot be located in the ICD-10 Alphabetical Index.

If the syndrome contains multiple components, but the Orphanet site only suggests a single ICD-10 code, then the coding standard DGCS.7: Syndromes must also be followed.

We also recommend that you liaise with the responsible consultant, discuss with neighbouring trusts and with Coding Managers nationwide via the Clinical Coding Managers Workspace on Delen. Note: this is a closed workspace specifically for registered Clinical Coding Managers. If you are a Coding Manager and would like to join the workspace, please register via Delen.

Where a new procedure or intervention has been performed or clinical practice has changed that impacts OPCS-4 codes you can submit a change request via the NHS Digital Request Submission Portal (RSP). Users need to register first to request a change.

If your query is in scope of the helpdesk and you are still unable to resolve your query after following the steps above you can submit your query to us by completing the Classifications Query Submission Form in Word format. Email your completed form to our helpdesk at information.standards@nhs.net.  

What happens to your query

1. Query logged

  • On receipt of your query, we will perform a further check to ensure it meets the submission criteria. If we feel that the query is out of scope of the helpdesk, we will return it to you with guidance on how to resolve it at source, within 48 hours of the query being logged.
  • All terminology and classifications queries are received by our Service Desk based in Exeter. The Exeter team performs an initial check of the submitted documentation to ensure no person identifiable information is present. If the query is not fully anonymised, they will return it to the originator. The Service Desk then send the query to our Product Support team.
  • If we accept your query, it will be placed in the queue on our tracking system for a member of the Product Support team to answer. The priority of all our incidents is set based on the organisation submitting the query, for example, queries received from Department of Health and Social Care (DHSC) are prioritised over all other queries because of the nature of the requests.

2. Query in progress

  • All queries go through a robust process whereby all resources readily accessible by the coding service are referred to during the review, and classifications expertise is applied. Additionally, the owner will search our Service Desk system to see if the same question has been answered previously and if so, will check whether the response is appropriate for the current query and supporting information. If the response has been added to the Query Resolution Database, the database UID will be sent to the query originator. 
  • As part of the review, all queries are reviewed by a second member of the Product Support team. In instances where consensus cannot be reached, the query will be inspected by a senior member of the team and subsequently may be presented at our Quality Assurance meeting for wider team consensus. Queries of this nature take longer to answer, so you may experience a delay in receiving the resolution, but we will send you a holding response to keep you informed.
  • As part of the resolution process we aim to identify and address instances where:
    • An existing coding standard/guidance is incorrect or out-of-date
    • An existing coding standard/guidance that is ambiguous/open to interpretation and would benefit from improvement
    • The lack of a coding standard/guidance is creating a problem for coding and a new standard/guidance is required.
    • An error or potential area for improvement in the classification needs to be addressed.

3. Query resolved

  • Finally, the resolution is sent back to the originator. If we consider that the response will benefit the wider coding service, it will also be uploaded to the Query Resolution Database.

About us

Our Classifications Product Support team consists of one full time and two part time members of staff who are all ACC qualified and have previous experience of working in NHS Trusts in a variety of roles such as Clinical Coding Managers, Approved Clinical Coding Auditors and Approved Clinical Coding Trainers. We receive coding and classification queries from a variety of sources, including clinical coding professionals, information analysts, Commissioning Groups, Members of Parliament, journalists and academic institutes. The queries are of varying complexity ranging from a single ICD-10 or OPCS-4 code to ‘shopping lists’ requiring multiple code combinations and advice on how the codes can be used to extract meaningful data for a particular group of diagnoses or procedures.

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