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The National Clinical Coding Qualification (UK) is the only nationally recognised qualification for clinical coders working in the NHS. Upon passing the examination a clinical coder is able to use the post-nominal letters ACC.
A novice NHS clinical coder needs to agree a 2-3 year development plan with their employer to complete the necessary training, acquire the skills, knowledge and practical work experience to become competent in clinical coding and be ready to sit the examinations to achieve accreditation. The breadth of coding skills and knowledge which is covered by the National Clinical Coding Examination are derived from the framework of the national clinical coder curriculum.
The National Clinical Coding Qualification (NCCQ) is the nationally recognised quality standard which provides independent assurance of the clinical coding practitioners’ competency in the use of the clinical classifications and knowledge of how to apply their associated rules, conventions and national clinical coding standards. Any clinical coding manager can be assured that a holder of the qualification (Accredited Clinical Coder/ACC) has been assessed and met these minimum standards.
The qualification is therefore invaluable in aiding robust recruitment processes. However, it need not act as a barrier to hold back an individual’s career progression. Trusts may have in place their own criteria for the on-going assessment and professional development of their employees in-line with local policies on staff development and the NHS Terms and Conditions of Service (section 31). As the recognised national qualification the NCCQ is a pre-requisite criteria for certain specialised career pathways – including the formal assessment of approved clinical coding auditors and trainers – to demonstrate eligibility. The qualification also acts as evidence of compliance with Data Security and Protection Toolkit (DSPT) Data Standard 3 and can help an organisation towards meeting those standards.
Attainment of the NCCQ is only one step in a coders career and in order for their ACC status to maintain currency practitioners must also be able to demonstrate continuing professional development and adherence to the requirements described in the Clinical Coding Training Handbook, i.e. attendance of a Clinical Coding Refresher Course every 3 years.
The qualification was established by NHS Connecting for Health in partnership with administration and awarding body, the Institute for Health Record and Information Management (IHRIM). It was also developed in collaboration with the NHS Scotland, NHS Cymru, and the Health and Social Services Executive (Northern Ireland).
The National Clinical Coding Qualification (UK) supports the need for good quality clinical information, as outlined in the Information for Health and the NHS Plan. One of the driving purposes of creating the NCCQ (UK) was to create a structured career path within Clinical Coding in the UK.
The NCCQ has become more popular in recent years. Agenda for Change (AfC) arrangements, contractual obligations and Continuing Professional Development (CPD) are seen as the driving forces.
Certainly since AfC's inception in 2004 it is not uncommon for a Clinical Coder's contract to include a requirement to take the NCCQ within a set time frame from the Coder's starting date (NHS Digital and IHRIM recommend a development plan of two-three years to acquire the theoretical and practical skills to be ready to sit the examinations. In many trusts passing the NCCQ is an instant promotion under AfC. However, the actual 'banding' can vary from region to region and indeed trust to trust. Having the NCCQ is quickly becoming a prerequisite of team leader and coding manager positions throughout the UK. Clinical Coders who wish to become approved auditors or trainers must have attained the NCCQ.
The NCCQ exam is taken over the course of one day.
In the morning there is a three hour practical paper which is split into three sections.
• A1 Quick fire ICD-10 questions (15% of the marks)
• A2 Quick fire OPCS-4 questions (15% of the marks)
• B Case Study (70% of the marks)
There are 15 questions in sections A1 and A2 and seven case study questions in Section B. The first case study requires Index trails from the Alphabetical Index (Volume 3)
In the practical paper the coder is allowed their tabular and index copies of ICD-10 and OPCS 4 (annotated with coding clinics) and a copy of BNF. Medical dictionaries are not allowed.
The pass mark is 90%, with a distinction given for achieving a pass mark of 95% or more.
In the afternoon the three hour theory paper test the coder’s knowledge of the theory of ICD-10, OPCS-4, Snomed CT, medical terminology and anatomy and physiology. Coders are not allowed to take any additional materials into this exam.
The pass mark is 60%, with a distinction given for those achieving a pass mark of 80% or more.
Paper 1 Practical
You must bring your own copies of:
- ICD-10 5th Edition (2016) Tabular List & Alphabetical Index only, Volume 2 Instruction Manual must not be brought
- OPCS-4.8 Tabular List & Alphabetical Index
NB You will not need to bring a copy of the previously issued Transport Accidents pamphlet as these instructions can now be found in the ICD-10 5th Edition Tabular List starting on page 900.
You will not be able to borrow books from invigilators or fellow candidates.
National Clinical Coding Standards (NCCS) Reference Books must not be brought in to the examination room; this equally applies to all printouts/photocopies of any individual pages you have inserted within your copies of the classifications.
Printouts, photocopies and handwritten transcriptions of the flowcharts that are found in the NCCS ICD-10 5th Edition (2016) Reference Book are not permitted and must not be present in your books, these include:
- DFigure.IX.1 Myocardial infarction and myocardial infarction with other forms of ischaemic heart disease, p98
- DFigure.XV.1: Complications following ectopic pregnancy, molar pregnancy, miscarriage and termination of pregnancy (O08), p143
- DFigure.XIX.7: Postprocedural complications and disorders, p189
Your books may be inspected by the invigilators to make sure that they do not contain any additional material that would give you an unfair advantage.
You may bring an annotated copy of the BNF and/or MIMS although this is not an essential requirement.
You must not bring a dictionary of any type into the examination room.
Copies of the mandatory co-morbidity list (Coding Clinic Ref 88), COPD coding table (coding standard DCS.X.5) and Pain relief procedures coding table (coding standard PCSA2) will be provided to you on your desk in the examination room.
Copies of the National Tariff High Cost Drugs List and National Tariff Chemotherapy Regimens List will also be provided when these are required to answer any question(s) contained in the practical examination paper; you will not need to bring your own copies.
Paper 2 Theory
You may not take any books or papers into Paper 2 Theory Paper.
Resits are possible. The coder is able to retake individual papers but must pass within the next 3 examinations or they will have to retake both papers again
There are 2 laptops available to ensure IHRIM's examinations are accessible. Allocation will be subject to meeting certain health criteria and will be allocated on a first come first served basis.
Changes to operational arrangements
NHS Digital – Terminology and Classifications Delivery Service and the Institute of Health Records and Information Management (IHRIM) have agreed operational changes to support the delivery of the National Clinical Coding Examinations.
The Terminology and Classifications Delivery Service and IHRIM partnership is a voluntary arrangement and the design, development and delivery of the assessment has been a natural evolution over a number of years.
Following a review of organisational roles and responsibilities, it was agreed the development of the assessment would be transferred to IHRIM from 1 April 2014.
Transitional arrangements were implemented to ensure a smooth handover and knowledge transfer during the first year of change. IHRIM is committed to supporting the assessment and ensuring it continues to be delivered effectively and efficiently. The September 2014 examination was the first one delivered under this new arrangement.
The Terminology and Classifications Delivery Service undertakes assurance of standards in line with the NHS Digital current syllabus, programme of study, national classification and clinical coding standards.
Oversight of the National Clinical Coding Qualification will be undertaken through the Partnership to ensure it is a robust and rigorous assessment of clinical coders’ knowledge and skills to demonstrate a minimum level of clinical coding competency.
A Memorandum of Understanding will be signed by both organisations going forward, to reflect the partnership arrangements. Both organisations remain committed to the recognition of competent clinical coders, part of the health informatics discipline within health and social care.
Notice to service
Please be aware the National Clinical Coding Qualification Examination Quality Assurance Board have made the decision that from September 2019 there will be no requirement to provide index trails for the first case study in the practical examination paper.
The index trails were originally included in all case studies to assess whether candidates were able to follow the 4 step coding process. On review it was felt that by identifying the correct codes the candidates were already demonstrating this skill and including the index trails did not provide further or enhanced representation of the candidates’ understanding of the principles and use of the classifications.