1. RIS Coding & Diagnostic Image Descriptors Rhidian Bramley PACS & Teleradiology SIG BIR, London 2006

2. Radiology procedure coding Cluster best practice working groups –London/Southern clusters –NWWM cluster –NE cluster (West Yorks) RCR PACS SIG coding subgroup –Mapped cluster lists & NHS costing manual –Debated purpose of coding, criteria for procedure inclusion/exclusion & terminology –Developed and endorsed procedure short codes

3. CPELVB Modality X - X-ray F - Fluoro I - Interventional C - CT M - MRI U - Ultrasound N - Nuc Med P - PET E - Endoscopy Z - Image analysis or review Post- qualifier (Extra or sub- descriptor) 4 th letter reserved for R, L, B or W if procedure R or L lateralisable, Both or Whole body, otherwise can be used for any letter or number Three or four letter descriptor body part / function code Procedure Short codes

4. CANKRB Modality X - X-ray F - Fluoro I - Interventional C - CT M - MRI U - Ultrasound N - Nuc Med P - PET E - Endoscopy Z - Image analysis or review Post- qualifier (Extra or sub- descriptor) 4 th letter reserved for R, L, B or W if procedure R or L lateralisable, Both or Whole body, otherwise can be used for any letter or number Three or four letter descriptor body part / function code Procedure Short codes

5. SNOMED CT radiology subset RCR & NHS Information Authority –Defined subset of radiology procedures (concepts) –Hierarchical structure (grouped by modality) –Post coordination (e.g. laterality) SNOMED CT Diagnostic Imaging Workshop –Purpose and principles for inclusion of a code in subset –Standard terminology for procedure descriptors SNOMED CT DI Subgroup –Decision to map SIG/Southern cluster list to SNOMED CT subset, creating new subset concepts

6. Coding governance relationships and responsibilities SNOMED CT subset Southern/London Cluster List NWWM Cluster List NEEM Cluster List Individual Trust Lists LSP or Trusts ??? maintain local list and mapping to SNOMED CT subset NPfIT, RCR etc ??? maintain SNOMED CT subset

7. National SNOMED CT imaging subset coding governance SNOMED CT Diagnostic Imaging procedures subset management group –NHS CfH Terminology service –Royal College Radiologists Special interest group representation –Society of Radiographers –British Nuclear Medicine Society –PACS National Clinical Reference Panel –Clinical representatives from LSPs –Department of Health (national clinical advisor) –Representative of secondary uses service –Cross border representation?

8. Revised coding governance relationships and responsibilities SNOMED CT subset SNOMED CT Diagnostic Imaging procedures subset management group Stakeholders Interim ‘mapped’ SNOMED CT representation procedure list Professional Clinical Groups LSP and trust representatives Other Stakeholders

9. Next steps & challenges Provide more responsive and timely submission and review process Incorporate and map to OPCS 4.3 subset for interventional radiology procedures Involve special interest groups in line item validation and review of procedure codes Continue to evolve principles and priorities for population of interim list and SNOMED CT subset Produce operational procedure notes for specific uses cases e.g. outside imaging review Firm up relationship to CfH governance structures

10. Sample submissions Tizzardogram MRI-Skeletal Survey (Footballer) MRI-Skeletal Survey (Goalkeeper)

11. Contacts Ian Arrowsmith –NHS Terminology Service (Chair) Paul Richards –NHS Interim representation list manager Rhidian Bramley –RCR Representative/Coordinator Kishore Reddy –Department of Health clinical lead on coding