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 umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) hospitals of
NHS England
NHS England, officially the NHS Commissioning Board, 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 side of the ...
,
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 ( cy, GIG (Gwasanaeth Iechyd Gwladol) Cymru) 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 ...
and
Health and Social Care in Northern Ireland
Health and Social Care (HSC) ( ga, Sláinte agus Cúram Sóisialta, ) is the publicly funded healthcare system in Northern Ireland. Although having been created separately to the National Health Service (NHS), it is nonetheless considered a ...
. It is based on the earlier
Office of Population Censuses and Surveys
The Office of Population Censuses and Surveys (OPCS), was created in May 1970 through the merger of the General Register Office and the Government Social Survey Department.
It was a forerunner and constituent, with the UK Central Statistical Of ...
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 car ...
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 health car ...
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 1987, by the Office of Population Censuses and Surveys (OPCS) as the ''Classification of Surgical Operations''. In 1992 the 4th revision was released as the ''OPCS Classification of Surgical Operations and Procedures (4th revision)'',
usually shorted to OPCS-4.2. Responsibility for the classifications used in the NHS, including OPCS-4, passed to the
NHS Information Authority
The NHS Information Authority (NHSIA) was part of the United Kingdom, UK National Health Service (NHS). It was established as a NHS special health authority by an Act of Parliament in April 1999. With headquarters in Birmingham, UK, its aim was ...
(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 and was formed on 1 April 2005, having replaced the former NHS Information Authority. It was part of the Department of Health Informatics Directorate, with the role ...
(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)
*Up to 31 March 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
*Since 1 April 2020 OPCS-4.9 (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
NHS Digital is the trading name of the Health and Social Care Information Centre, which is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England, particularly th ...
; responsibility for OPCS-4 remains with NHS Digital.
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
A bracket is either of two tall fore- or back-facing punctuation marks commonly used to isolate a segment of text or data from its surroundings. Typically deployed in symmetric pairs, an individual bracket may be identified as a 'left' or 'r ...
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 Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
. 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. It is used for several purposes, most often to mark the end of a declarative sentence (as distinguished from a question or exclamation ...
(.) 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 la, rubrica, meaning red ochre or red chalk, and originates in Medieval illuminated manuscripts from the 13th cent ...
.
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 various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
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 person, a place, or a thing after whom or which someone or something is, or is believed to be, named. The adjectives which are derived from the word eponym include ''eponymous'' and ''eponymic''.
Usage of the word
The term ''epon ...
, 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
Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap (usually made of cobalt-chrome metal), which is hollow and shaped like a mushroom, over the head of the femur whi ...
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 (half) replacement. Such joint replacement or ...
.
Care must be taken when using trailing via Section II for two reasons:
#The eponyms given are based on the original description, of the original procedure. If a modified version of the procedure was performed, for example a modified Akin
osteotomy
An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is ...
, or if the operation has been performed in conjunction with another procedure, e.g. Akin and Scarf osteotomies, the W15.6 code given in the index may not be correct.
#Only a single term is used to index the eponyms, i.e. ''Birmingham'' rather than Birmingham hip resurfacing. This means that care must be taken where the same eponym has been used more than once. For example, ''Thompson'' has four separate entries that apply to different procedures: Thompson's lymphoedema correction, cemented Thompson hemiarthroplasty, uncemented Thompson hemiarthroplasty, and Thompson's quadricepsplasty
Section III – Alphabetical Index of Surgical Abbreviations
This section of the Volume II contains an alphabetical list of common
abbreviations
An abbreviation (from Latin ''brevis'', meaning ''short'') is a shortened form of a word or phrase, by any method. It may consist of a group of letters or words taken from the full version of the word or phrase; for example, the word ''abbrevia ...
and their definitions. For example,
ECMO
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequat ...
- 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 grc, γλῶσσα, ''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. Tradi ...
that defines
suffixes
In linguistics, a suffix is an affix which is placed after the Stem (linguistics), stem of a word. Common examples are case endings, which indicate the grammatical case of nouns, adjectives, and verb endings, which form the Grammatical conjugation ...
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 Payment by Results (PbR) is a type of public policy instrument whereby payments are contingent on the independent verification of results. It is being actively promoted by a number of governments for more effective implementation of domestic policy. ...
team; the High Cost Drugs List is a catalogue of drugs licensed for use in the NHS that are excluded from the Payment by Results (PbR) tariff.
Issued annually - 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 states that it is 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 to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...
. Organised alphabetically, the list contains adult and paediatric chemotherapy regimens used in the NHS.
Drug trials
Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
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
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'sSchedule of Procedures is based upon OPCS-4.
See also
*
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
References
External links
Official siteby NHS Digital
{{Medical classification
Clinical procedure classification
Medical classification
National Health Service