Heart failure versus left ventricular dysfunction.
The consequence of this coding issue for LVD is that if for example you code an HF patient with a G58 code, “Heart failure” or with G580. “CCF”, then the patient does not have HF due to LVD in the QOF definition. Therefore they will not need ACEs/beta blockers for HF3/HF4 indicators.
This can either be an advantage (if your patient is 98 and you judge that clinically the risks outweigh the benefits.
It could also be a disadvantage, if this patient has been started on those drugs but you’re not getting the credit under the QOF analysis, or if you use prompting software to remind you of QOF requirements as such patients won’t get those prompts (because they don’t fulfil the definition of patients with HF due to LVD).
We had some patients coded with G58.. “Heart failure”. Since this doesn’t imply LVD, their ACE and Beta blocker blocker treatment wasn’t counting for us. By adding an LVF code, if appropriate, the patient drops into the denominator and the numerator groups for HF3 and HF4.
By understanding this, you can choose codes which are an accurate representation of the clinical situation and also maximise patient care and practice profits too.
Only three beta blockers are valid for HF4: bisoprolol, carvedilol and nebivolol.
If a patient’s in the denominator for HF4 and you prescribe one of the above, you will score the points. If the patient is on a Beta blocker, but it’s an unlicenced one, the patient is completely removed from the denominator group (so they neither score for you, nor against you).
So, providing they’re also on an ACE/ARB, you can increase your scores for this indicator by changing a patient from an unlicenced Beta blocker (like Atenolol) to one that is licenced, (like bisoprolol for example), if you feel that’s appropriate.
HF2 requires you to refer patients with HF for an echocardiogram to confirm the diagnosis. This must be from three months before you add the diagnosis to 12 months after.
If you inherit a patient diagnosed with Heart failure but without evidence of an Echo, and apparently stable on treatment you might take the view that it’s inappropriate to retrospectively send them for an Echo – for example if they are very frail or severely demented.
In such a case, you might use the exception code 9hH0. Heart failure: Patient unsuitable. This would exempt the patient from any HF indicators he wasn’t scoring. Note, however, that it’s an expiring code and so would need re-adding the following year (see my previous article on exception coding).
Ensure that all your relevant clinicians understand what “Heart Failure due to LV Dysfunction” means, and consider retrospectively going through your HF list to ensure you’ve coded them as you now want them coded.
Review patients on ACEs. Can you add a licenced beta blocker? Are any HF patients taking unlicenced beta blockers that you want to change?
Who, in your Heart failure list, are not scoring for HF2? Can you do anything about them, such as referring them or exception-coding them?
Dr Simon Clay is a GP in Erdington, Birmingham.
Has inspired me to look at heart failure coding.
My practice coleague and I use Instillagel for all our fittings and it works really well. We do not routinely refer Nulliparous women to other services and have encountered barely any failed insertions in this group, who are increasingly asking for and IUD/IUS. Good procedure counselling and preparation is essential to success and some appropriate analgesia beforehand is also useful.