UK primary care coding of covid-19 is a mess: we need to stop the use of bad codes, and migrate from the use of ugly to good codes, but will only be able to do so when they are finally released .
Key data computerised medical record (CMR) systems are recorded using ’codes’, to standardise recording and so attendances about a medical problem can be linked.1 At the start of the COVID-19 pandemic there was neither international agreement about nomenclature nor codes available in primary care CMRs with which to record exposure, testing, or infection.
We have now been through three iterations of clinical codes in the UK since the end of January. Five temporary codes were added to all the primary care CMR systems using the ‘2019 nCoV (Wuhan)’ label in January 2020. Subsequently NHS Digital, the NHS coding organisation, released a more extensive set of SNOMED CT concepts named ‘2019 nCoV (novel coronavirus)’ because the use of ‘Wuhan’ had been deprecated; these codes were in turn replaced by ‘SARS –CoV-2 (severe acute respiratory syndrome coronavirus 2)’ 2
The situation has been further complicated by the fact that this last release is only now starting to become available in CMRs (Table 1), and because some clinicians have gone back to using old non-specific coronavirus codes (such as ‘ Suspected Coronavirus infection: 1JX ’, and ‘ Coronavirus infection: A795 ’).
Table 1. Clinical concepts that should be coded, temporary and definitive codes.
| Clinical concepts that should be coded in CMR | Temporary codes Go on using until replaced by SARS-Cov-2 |
Final SNOMED CT description Roll-out taking place during April 2020 |
|---|---|---|
| Exposure to COVID-19 | Exposure to 2019 nCoV (Wuhan) infection or | Exposure to SARS-CoV-2 infection |
| Exposure to 2019 nCoV (novel coronavirus) infection | ||
| Suspected COVID-19 infection | Suspected 2019 nCoV (Wuhan) infection or | Suspected COVID-19 |
| Suspected 2019 nCoV (novel coronavirus) infection | ||
| Test for COVID-19 offered or taken | No specific codes | Swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) taken by healthcare professional |
| Self-taken swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) offered | ||
| Self-taken swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) completed | ||
| Tested for 2019 nCoV (Wuhan) infection or | ||
| Tested for 2019 nCoV (novel coronavirus) infection | ||
| COVID-19 definite case | Confirmed 2019 nCoV (Wuhan) infection or | COVID-19 |
| Confirmed 2019 nCoV (novel coronavirus) infection | ||
| COVID-19 excluded | Excluded 2019 nCoV (Wuhan) infection or | COVID-19 excluded |
| Excluded 2019 nCoV (novel coronavirus) infection | ||
| Laboratory test codes | ||
| COVID-19 confirmed by lab test | COVID-19 confirmed by laboratory test | |
| COVID-19 excluded by lab test | COVID-19 excluded by laboratory test | |
| COVID-19 virus detected | 2019-nCoV (novel coronavirus) detected | SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) detected |
| COVID-19 virus not detected | 2019-nCoV (novel coronavirus) not detected | SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) not detected |
CMR = computerised medical record.
This creates challenges for the surveillance system and others monitoring the pandemic.3 We have previously classified the incorrect use of codes as miscoding, misclassification, or misdiagnosis.4 In the cases of COVID-19, we are seeing1 both Miscoding (that is, continued use of the temporary codes, which should stop once the new ones are available);2 and Misclassification (use of non-specific coronavirus codes), which should stop. Table 1 sets out the clinical concept we currently need to consistently record in primary care, the temporary codes available to do this, and the final codes we should all eventually use. Prompt cards to help clinicians and coders are available at: https://clininf.eu/index.php/cov-19/
All UK primary care clinicians and coders are recommended to continue to use the temporary codes until the new ones are available, then switch. Accurate data is a key to understanding and monitoring the course of this pandemic.
Appendix: Examples of codes not to use
Exposure to coronavirus infection
Suspected coronavirus infection
Coronavirus infection
Disease due to Coronaviridae
Coronavirus contact
Funding
N/A
Ethical approval
N/A
Provenance
Commissioned; not externally peer reviewed.
Competing interests
The authors declare that no competing interests exist.
References
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