Procedure, Immunisation, Pathology & Medicare codes reference

Find the active ICPC-2 PLUS Procedure, Immunisation, Pathology and Medicare codes for NKPI reporting here.

Annual Health Assessments

Currently (February 2018) annual health assessments are only referenced in nKPIs by the associated Medicare claim (715, 228, 92004, 92016, 92011, 92023).

For OSR reporting the following System Codes are referenced on clinical items only whenever a patient has no claim for Medicare item 715 (or 228, 92004, 92016, 92011, 92023):
  • AHC for adult annual health checks
  • CHC for child annual health checks
  • OHC for over-55s annual health checks

Care Plans

Currently (February 2018) care plans are only referenced in nKPIs by the associated Medicare claim (721 721, 229, 92024, 92068, 92055, 92099).
  • The System Code used to identify care plan assessments is CPA.
  • The System Code used to identify Team Care Arrangements is TCA.

Pregnancy and Cervical Screening Items

These Rule Codes are referenced:
  • PR-CHECK – any procedure identified by this rule code will be deemed to be an antenatal check. By checking the pregnancy number and then looking for an explicit gestation or by comparing with the pregnancy outcome, the trimester in which the first antenatal check was performed can be calculated.
These Export Codes are referenced:
  • CST, HPV, LBC - any procedure that is evidence that a cervical screening test, human papillomavirus or liquid based cytology has been performed.

Substance Use (Drug and Alcohol) Items

These Export Codes are referenced:
  • DA-ENROL – identifies a formal enrolment to a course of drug and alcohol treatment. If this clinical item has a reference qualifier with an export code of ‘DA-TDS’ where a reference with an export code of 2 has been recorded then the treatment is deemed to be residential.
  • DA-EXIT – formally marks the end of a period of drug and alcohol treatment.
  • DR-ENROL – identifies the start of a period of respite for patients receiving drug and alcohol treatment.
  • DR-EXIT - formally marks the end of a period of respite.
  • DA-SUOS – identifies an occasion of sobering up during an overnight stay

Immunisations

Influenza immunisations are recognised using the Export Codes on clinical items of type Immunisation;brand code for the GNFLU vaccine and its equivalents, described in Equivalent and partial equivalent vaccines table - GNFLU entry. For example, GNFLU, PANVAX, FLUVAX, and so on. These vaccines may change annually.

Note: Listed in the Non-standard vaccines and Equivalent and partial equivalent vaccines tables are
  • COVID-19 vaccines. For example, AstraZeneca COVISHIELD (ASTCOV), Bharat Biotech Covaxin (BHACOV), Pfizer Comirnaty (COMIRN), AstraZeneca Vaxzevria (COVAST), Gamaleya Sputnik V (GAMSPU), Moderna Spikevax (MODERN), Novavax NUVAXOVID (NOVNUV), Sinovac Coronavac (SINCOR).
  • Monkey Pox vaccines. For example, ACAM2000 (ACAM), Generic Smallpox (GNPOX), JYNNEOS (JYNNEO).
For customers using the Immunisation Vaccines dataset, example codes include:
  • Immunisation;flu, GNFLU
  • Immunisation;influenza, GNFLU
  • Immunisation;Afluria Quad, AFLR
  • Immunisation;Agrippal, AGRPAL
  • Immunisation;Flucelvax Quad, FCELQD
  • Immunisation;Fluzone High-Dose Quad, FLHDQD
  • Immunisation;Fluarix, FLRIX
  • Immunisation;Fluad, FLUAD
  • Immunisation;Fluzone High-Dose, FLUHID
  • Immunisation;Fluad Quad, FLUQAD
  • Immunisation;Fluarix Tetra, FLUTET
  • Immunisation;bioCSL Fluvax, FLUVAX
  • Immunisation;Fluvirin, FLVRN
  • Immunisation;FluQuadri Junior, FQDJN
  • Immunisation;FluQuadri, FQUAD
  • Immunisation;Fluvax Junior, FVXJNR
  • Immunisation;Influvac Tetra, INFLTA
  • Immunisation;Influvac, INFLUV
  • Immunisation;Panvax (H1N1 Influenza), PANVAX
  • Immunisation;Panvax (H1N1) 0.25ml, PANVAX
  • Immunisation;Panvax (H1N1) 0.5ml, PANVAX
  • Immunisation;Vaxigrip, VAXGRP
  • Immunisation;Vaxigrip Tetra, VAXTET
  • Immunisation;Vaxigrip Junior, VGRJNR

Immunisation Reviews

Immunisation reviews must be named as indicated here (case insensitive):
  • Starts with REVIEW;IMMUNISATION;6 MONTH
  • Starts with REVIEW;IMMUNISATION;12 MONTH
  • Starts with REVIEW;IMMUNISATION;18 MONTH
  • Starts with REVIEW;IMMUNISATION;4 YEAR
Export codes were introduced for June 2018 reporting and are included here for health services who wish to name their immunisation review items differently:
  • IMRV-BIR REVIEW;IMMUNISATION;BIRTH
  • IMRV-02M REVIEW;IMMUNISATION;2 MONTH
  • IMRV-04M REVIEW;IMMUNISATION;4 MONTH
  • IMRV-06M REVIEW;IMMUNISATION;6 MONTH
  • IMRV-12M REVIEW;IMMUNISATION;12 MONTH
  • IMRV-18M REVIEW;IMMUNISATION;18 MONTH
  • IMRV-04Y REVIEW;IMMUNISATION;4 YEAR
  • IMRV-12Y REVIEW;IMMUNISATION;12 YEAR
  • IMRV-50Y REVIEW;IMMUNISATION;50 YEAR

Group Activity

For OSR group activity recording the following export codes are recognised as group activity:
  • HP-GRPT will be resolved as 'Tobacco use treatment/prevention groups'.
  • HP-GRPA will be resolved as 'Alcohol misuse treatment/prevention grps'.
  • HP-GRPP will be resolved as 'Physical activity/healthy wt activities'.
  • HP-GRPC will be resolved as 'Chronic disease client support groups'.
  • HP-GRPL will be resolved as 'Living skills groups'.
  • HP-GRPU will be resolved as 'Cultural groups'.
  • HP-GRPM will be resolved as 'Men's groups'.
  • HP-GRPW will be resolved as 'Women's groups'.
  • HP-GRPY will be resolved as 'Youth groups'.
  • HP-GRP will be resolved as the name of the clinical item.
These additional codes are used for the maternal and child health group activities:
  • MCH-GRPA will be resolved as 'Antenatal groups'.
  • MCH-GRPM will be resolved as 'Maternal and baby/child health groups'.
  • MCH-GRPP will be resolved as 'Parenting and parenting skills groups'.
  • MCH-GRP will be resolved as the name of the clinical item.

Pathology

For some indicators, reference is made to pathology requests or results recorded in a patient record. For example, cervical screenings can be identified by the recording of a clinical item or a qualifier but also by the recording of a test request or the receiving of a test result.

Test Requests

Cervical screening: Request terms with the keywords of CST, HPV, or LBC will be recognised as requests for cervical screening test, human papillomavirus or liquid based cytology.

Review your request term keywords at File > Reference Tables > Investigations > Investigation Keywords.

To print out a list, run the report at Report > Reference Tables > Investigation Keywords.

Test Results

For cervical screening, results are recognised if the name of the test returned by the lab includes any of the following strings of text (all case insensitive):
  • CST
  • HPV
  • LBC
  • CERVICAL SCREEN
  • GYNAECOLOGICAL CYTOLOGY
  • NCSP

Medicare Claims

The following Medicare claim numbers are referred to in the nKPI indicators:
  • 715 (228, 92004, 92016, 92011, 92023): [nKPI, OSR] Annual health assessments for Indigenous patients.
  • 721 (229, 92024, 92068, 92055, 92099): [nKPI, OSR] GP management plans
  • 10986: [OSR only] Healthy Kids Check performed by nurse or Aboriginal Health Practitioner.
    Note: This Medicare item was made inactive on 1st November 2015 but the indicator still references this item.

Health Care Home Trial

Enrolment in the Health Care Home Trial is managed using clinical items with these codes:
  • HC-ENROL – this should be the rule code and export code for the enrolment item
  • HC-EXIT – this should be the rule code and export code for the exit item