Advanced notification of Changes to the National Clinical Coding Qualification (UK) from April 2022

To help students revise, and to assist managers and trainers to support their trainees, we have published this advance information about changes to the NCCQ (UK) Paper 2 – Theory Exam.

The changes will:

  • improve the exam structure
  • ensure the exam content is better aligned to the objectives of the syllabus
  • ensure that candidates are fully demonstrating the knowledge and skills encompassed by the syllabus, that are valued by employers and are required for onward career progression.

These changes will be effective from 1st April 2022 and be formally introduced in the September 2022 NCCQ (UK) examinations.

There are no changes to Paper 1 – Practical Exam.



The National Clinical Coding Qualification (NCCQ) (UK) was established in 1999 by the former NHS Centre for Coding and Classification – now the NHS Digital - Terminology and Classifications Delivery Service – working in partnership with the Institute of Health Records & Information Management (IHRIM).

The accuracy of the coded medical record is essential to Health Care Providers and forms part of hospital data for national reporting for statistical analysis; provides insight on trends, informs public health investments, service planning and reimbursement to hospitals for the care they have provided. Consequently, the qualification requires a high level of attainment to demonstrate clinical coding competency in a practitioner.

The NCCQ (UK) is a basic level qualification to demonstrate competence as a clinical coding professional and provides a recognised benchmark at this level for clinical coding in the NHS.

The coronavirus (COVID-19) pandemic has changed the way the NCCQ (UK) examination is delivered, and in 2021 IHRIM transformed the assessment processes to offer a digital exam for the first time.  This new delivery format uses the same content structure to retain the familiar ‘look and feel’ of the traditional pen and paper-based examination. There have been a lot of lessons learned in making this switch and IHRIM are committed to continual improvements to take advantage of the opportunities offered to clinical coding students by digital testing.

Following extensive discussions between the Partnership members, and approval by the Examination Quality Assurance Board, a decision has been made to update the content and structure for the 2022-23 exam series. To ensure a better balance between the exam content of Paper 1 and Paper 2, reduce syllabus creep, and improve standardisation of the exam questions it has become desirable to re-focus the theory content on the rules, conventions and other principles that guide the use of the classifications. Going forward the NCCQ (UK) specification will undergo an annual review. 

What is changing:

In Paper 2 - Theory the following changes have been introduced:

  • Focus on the theory fundamentals such as ICD-10 and OPCS-4 classifications rules, conventions and general/chapter standards of ICD-10 and OPCS-4
  • Less focus on specific clinical coding standards (which are already covered in Paper 1)
  • Reduced scope of the questions in Section D[1] and D[2], and removal of question choice to simplify the structure and so all candidates will answer the same set of questions.
  • Guidance provided on the focus areas for each section in Paper 2 - Theory paper to support a student’s revision
  • Updated, more concise bibliography that will support streamlined revision

To reflect the streamline exam content, there will also be amendments to the percentage weighting, grade boundaries and overall pass mark for Paper 2 sections so that performance more accurately reflects candidate knowledge of the whole syllabus.

Paper 1 – Practical

Paper 2 - Theory

180 minutes (3 hours)

180 minutes (3 hours)

Annotated copies of ICD-10 Alphabetical Index and Tabular List, and OPCS-4 Alphabetical Index and Tabular List are required to take this exam

No materials can be taken into the examination room

90% Pass mark

70% Pass mark

95% Distinction

85% Distinction

Digital format only

Digital format only

A detailed overview of the amendments to Paper 2 – Theory Exam can be found in the NCCQ(UK) Paper 2 – Theory Technical Changes document.


  • Increased transparency of theory exam content
  • Improved focus on core knowledge for the theory exam
  • Greater consistency of questions across exam sittings
  • Concise bibliography for streamlined revision
  • Performance more accurately reflects candidate knowledge of the whole syllabus, and that attainment of the qualification better reflects this.

NHS Digital have confirmed that the 2022/23 NCCQ (UK) Revision Programme materials will fully reflect these changes to support approved clinical coding trainers delivering revision sessions.

What is not changing:

The NCCQ(UK) is designed for UK clinical coding professionals already working in secondary care and offers a clear pathway of progression for their clinical coding career.

The NCCQ(UK) remains a self-directed learning qualification that is assessed through completion of two invigilated online exams which candidates will only be able to access at the date and time they are registered to attend.

There are no changes to:

  • NCCQ (UK) Entry Criteria
  • NCCQ (UK) Examination Syllabus
  • Paper 1 – Practical Exam for 2022-23
  • Candidates will continue to be required to demonstrate their ability to apply current coding standards correctly in Paper 1 – Practical. Paper 1 will continue to focus on the full range of clinical specialties and test a candidate’s ability to apply codes using the four-step coding process in accordance with national clinical coding standards.
  • Online assessment

Clinical coders studying for the NCCQ (UK) should review the Syllabus, Framework and Bibliography and Self-Directed Learning Framework before registering for the qualification. These documents are available as a free download from the NHS Digital Delen page below.