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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 The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
(NHS) hospitals of
NHS England NHS England, formally the NHS Commissioning Board for England, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning si ...
,
NHS Scotland NHS Scotland, sometimes styled NHSScotland, is the publicly–funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland ...
,
NHS Wales NHS Wales () is the publicly-funded healthcare system in Wales, and one of the four systems which make up the National Health Service () in the United Kingdom. NHS Wales was formed as part of the public health system for England and Wales crea ...
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), and retains the OPCS abbreviation from this now defunct publication. OPCS-4 codifies operations, procedures and interventions performed during
in-patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...
stays, day case surgery and some
out-patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other h ...
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 The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
. As a publication, OPCS-4 is split into two volumes; a tabular list (Volume I) and an alphabetical index (Volume II). An electronic version is also available. However, a number of supplementary publications are also used by coding staff.


History

The first NHS procedural classification was published in 1970 by the Office of Population Censuses and Surveys (OPCS) as the ''Classification of Surgical Operations'', the second revision came in 1971. A completely re-written classification was produced and released in 1977, referred to as OPCS3. In 1989 the 4th revision was released as the ''OPCS Classification of Surgical Operations and Procedures (4th revision)'', with a second revision coming a year later 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 The NHS Connecting for Health (CFH) agency was part of the UK Department of Health (United Kingdom), Department of Health and was formed on 1 April 2005, having replaced the former NHS Information Authority. It was part of the Department of Healt ...
(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. Since the implementation of OPCS-4.3 in April 2006 there have been six further editions of OPCS-4 released. Each becoming the mandated classification on 1 April in the year of publication. OPCS-4 version mandated for use (financial year) *1989-1990 OPCS-4 *1990-2006 OPCS-4.2 *2006-7 OPCS-4.3 *2007-9 OPCS-4.4 *2009-11 OPCS-4.5 *2011-14 OPCS-4.6 *2014-17 OPCS-4.7 *2017-20 OPCS-4.8 *2020-23 OPCS-4.9 *Since 1 April 2023 OPCS-4.10 (until further notice) Whilst additions to OPCS-4 are reviewed on an annual basis, the long term plan is to replace OPCS-4 with
SNOMED CT SNOMED CT or SNOMED Clinical Terms is a systematically organized computer-processable collection of medical terms providing codes, terms, synonyms and definitions used in clinical documentation and reporting. SNOMED CT is considered to be the mo ...
. On 31 March 2013 NHS CFH ceased to exist. On 1 April 2013, the Health and Social Care Information Centre's (HSCIC) Clinical Classifications Service (CCS) became responsible for the revision and maintenance of OPCS-4. On 1 April 2016, HSCIC was rebranded to NHS Digital; responsibility for OPCS-4 remains with NHS Digital. NHS Digital merged with
NHS England NHS England, formally the NHS Commissioning Board for England, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning si ...
1 February 2023.


Volume I - Tabular List

OPCS-4 Volume I is split into 24 chapters: *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


I-codes

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


O-codes

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. For example: O04.- Embolisation Artery Aneurysmal Transluminal Percutaneous NEC (L).


Code structure

OPCS-4 is an alphanumeric nomenclature, and uses a four character code layout; similar to that found in
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...
. The first character is always a letter. With the exception of the O-codes mentioned above, the letter indicates the chapter the code is from. The second, third and fourth characters are always numbers. A
full stop The full stop ( Commonwealth English), period (North American English), or full point is a punctuation mark used for several purposes, most often to mark the end of a declarative sentence (as distinguished from a question or exclamation). A ...
(.) separates the third and fourth characters. Also, unlike ICD-10, there are no three character codes within OPCS-4. Although OPCS-4 is used to classify procedures and interventions, and ICD-10 classifies diagnoses; their chapters do not correlate. That is to say; Chapter A of OPCS-4 is not used to classify treatments for conditions in Chapter I of ICD-10.


Volume II - Alphabetical Index

OPCS-4 Volume II is an index for looking up codes in Volume I. It is bad practice to use it by itself, as some trails only index to the 3rd character category, rather than the 4th character
rubric A rubric is a word or section of text that is traditionally written or printed in red ink for emphasis. The word derives from the Latin , meaning red ochre or red chalk, and originates in medieval illuminated manuscripts from the 13th century or ...
. It is split into four numbered sections, along with an introduction section.


Introduction

The introduction gives a brief guide on using OPCS-4, and defines some abbreviations; for example .


Section I – Alphabetical Index of Interventions and Surgical Procedures

This is the main bulk of the index, and contains the mechanism of looking up codes within the tabular list. Terms are indexed in a , , method. For example,
oesophagogastroduodenoscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by #Alternative names, various other names, is a Medical diagnosis, diagnostic endoscopy, endoscopic procedure that visualizes the upper part of the gastrointesti ...
is trailed via Examination (the What), Gastrointestinal Tract Upper (the Where), Endoscopic Fibreoptic (the How).


Section II – Alphabetical Index of Surgical Eponyms

This list of surgical
eponyms An eponym is a noun after which or for which someone or something is, or is believed to be, named. Adjectives derived from the word ''eponym'' include ''eponymous'' and ''eponymic''. Eponyms are commonly used for time periods, places, innovati ...
, contains common NHS procedures that may also be known by the surgeon, team or institution that developed the method or device used. For example, the Birmingham hip resurfacing and the Thompson
Hemiarthroplasty Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint repla ...
. The eponyms list is no longer maintained and has not been updated since 2008 and is "only retained for legacy purposes"


Section III – Alphabetical Index of Surgical Abbreviations

This section of the Volume II contains an alphabetical list of common
abbreviations An abbreviation () is a shortened form of a word or phrase, by any method including shortening, contraction, initialism (which includes acronym), or crasis. An abbreviation may be a shortened form of a word, usually ended with a trailing per ...
and their definitions. For example, ECMO - Extracorporeal Membrane Oxygenation. As there are few instances where the abbreviation has been used more than once, and medical language is liable to change; descriptors are given to clarify all abbreviations. For example, SST could stand for Serum Skin Test or Short Synacthen Test.


Section IV – Alphabetical Index of Common Surgical Suffixes

This section of Volume II is a single page
glossary A glossary (from , ''glossa''; language, speech, wording), also known as a vocabulary or clavis, is an alphabetical list of Term (language), terms in a particular domain of knowledge with the definitions for those terms. Traditionally, a gloss ...
that defines
suffixes In linguistics, a suffix is an affix which is placed after the stem of a word. Common examples are case endings, which indicate the grammatical case of nouns and adjectives, and verb endings, which form the conjugation of verbs. Suffixes can ca ...
that are used throughout the classification. For example, -otomy.


Supplementary publications

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


Standards book

The ''National Clinical Coding Standards OPCS-4'' is a reference book on how to use the classification, and provides guidance through examples. It is initially supplied to novice coders who attend a standards course run by a CCS approved trainer. Whilst each revision to OPCS-4 sees the issue of a new manual; any updates or corrections are issued electronically, and the onus is on the coder to update them by hand. Prior to OPCS-4.7, and the move of maintenance responsibility to NHS Digital, the standards book was known as the ''Clinical Coding Instruction Manual''.


ICD-10 and OPCS-4 Classifications Content Changes

Minor changes and coding advice for both ICD-10 and OPCS-4 are disseminated through the ''ICD-10 and OPCS-4 Classifications Content Changes''. Until March 2022 this publication was known as ''The Coding Clinic'', which was initially issued as a printed newsletter. Then, in 2012, the format was switched to a single, compendium-like electronic publication.


High Cost Drugs List

Maintained by the Department of Health's (DH) Payment by Results team; the High Cost Drugs List was a catalogue of drugs licensed for use in the NHS that are excluded from the Payment by Results (PbR) tariff. Although reviewed annually; the list required updates to be published infrequently. Any changes that were made, however, would always be valid from the start of the next April – 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 stated that it was down to the clinical staff to use the generic instead of brand names.


Chemotherapy Regimens List

The Chemotherapy Regimens List, also issued by the DH Payment by Results team, is for the coding of administration of
antineoplastic drugs Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) in a standard regimen A regimen is a plan, or course of a ...
. Organised alphabetically, the list contains adult and paediatric chemotherapy regimens used in the NHS. Adult 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 of the DH lists are issued to coders via Terminology Reference Data Update Distribution Service (TRU

and on the NHS England platform Delen The Chemotherapy Regimens list has not been updated since 2017.


Copyright

As an NHS publication, OPCS-4 is covered by Crown copyright#United Kingdom, Crown Copyright.


Derived works

Th
Clinical Coding and Schedule Development (CCSD) Group's
Schedule of Procedures is based upon OPCS-4.


See also

*
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...


References


External links


Official site
by NHS England
OPCS-4.10
on the NHS England Classifications Browser {{Medical classification Clinical procedure classification Medical classification National Health Service