National Clinical Coding Qualification (UK)

The National Clinical Coding Qualification (UK) (NCCQ) is the only nationally recognised qualification for clinical coders working in the NHS.^[1] In order to obtain level 2 of the Information Governance Toolkit (IGT) requirement 510, acute trusts are expected to support coding staff in attaining the NCCQ.^[2]

For the coder, having the qualification is often an automatic promotion, and a prerequisite for getting on Health & Social Care Information Centre's National Clinical Coding Trainer and Auditor Programmes.^[3]

Upon passing the examination a clinical coder is able to use the post-nominal letters ACC.^[4]

Development

Established by the Institute for Health Records and Information Management (IHRIM), the NCCQ was developed in collaboration with the NHS England's Clinical Classifications Service, NHS in Scotland, NHS Cymru, and the Health and Social Services Executive (Northern Ireland).

With the advent of ICD-11 (which uses an entirely different format from ICD-10 it is not yet known how the NCCQ will remain relevant. Suggestions include a conversion exam for current holders of the qualification, as well as an entirely new examination that would require a resit by all holders of the NCCQ.

Purpose

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 was to create a structured career path within clinical coding in the UK. Since Agenda for Change (AfC), and with IGT requirement 510, coders new to the profession may find sitting the NCCQ is a contractual obligation (CfH recommends a minimum of 1 year's coding experience before sitting the exam). A coder is also able to use sitting the NCCQ to count towards their Continuing Professional Development (CPD).^[5] 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 generally a requirement for clinical coding lead and management positions throughout the UK, and is necessary for getting onto the only Department of Health recognised clinical coding trainer and auditor programmes.^[3]

Exam

The NCCQ exam is taken over the course of one day. The first time a coder takes the exam, they must sit both papers. For resits, one or both can be sat.

Practical paper

The 3 hour 'practical' paper is sat in the morning and gives the coder a selection of diagnoses and operations. The short answer, quick-fire section is split into ICD-10 and OPCS-4 subsections, requiring just the codes from the respective book. The long answer, 'essay' questions, require both the ICD-10 and OPCS-4 codes. In addition, the first essay question requires the coder to show their 'four-step-coding-process' as well as the codes chosen by the coder. 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. No medical dictionary is allowed. The pass mark is 90%,^[4] with a distinction given for getting 95% or more.

Theory paper

The 3 hour long 'theory' paper tests the coder's knowledge of SNOMED CT, the coding clinic, ICD-10, OPCS-4, Payment by Results (PbR), the Information Governance (IG) toolkit and anatomy and physiology. No reference material is allowed on the coder's desk for the theory paper. The pass mark is 60%, with a distinction given for a those getting over 80%.

Resitting

It is possible to resit the exam as a whole, or to retake individual papers. However, both papers have to be passed within 3 sittings to obtain the NCCQ. Should a coder fail to get both papers within 3 sittings they must resit both papers on the fourth (even if they had passed one of the papers previously).

References