National Clinical Coding

Training Handbook
2021-22
Terminology and Classifications Delivery Service

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National Clinical Coding Training Handbook 2021-22

Contents
1 Introduction 4
1.1 Purpose of document 4
1.1.1 Audience 5
1.1.2 Background 5

2 Clinical Coding Standards Course 6

2.1 Pre-requisite skills, knowledge and experience 6
2.2 Booking a place on the Clinical Coding Standards Course (CCSC) 7
2.3 Clinical Coding Standards Course Details 7
2.3.1 Course Overview 7

3 Clinical Coding Standards Refresher Course 14

3.1 Pre-requisite skills, knowledge and experience 14
3.2 Booking a place on the Clinical Coding Standards Refresher Course (CCSRC) 15
3.3 Clinical Coding Standards Refresher Course Details 16
3.3.1 Course Overview 16

4 NCCQ (UK) Revision Programme 20

4.1 Pre-requisite skills, knowledge and experience 21
4.1.1 Mandatory Pre-requisites 21
4.1.2 Desirable Pre-requisites 21
4.2 Booking a place on the NCCQ (UK) Revision Programme 22
4.3 NCCQ (UK) Revision Programme Details 23
4.3.1. Programme Overview 23

5 Mental Health Clinical Coding Training 29

5.1 Mental Health Clinical Coding Standards Course 30
5.1.1 Pre-requisite skills, knowledge and experience 30
5.1.2 Booking a place on the Mental Health Clinical Coding Standards Course
(MHCCSC) 31
5.1.3 Mental Health Clinical Coding Standards Course Details 31
5.1.3.1 Course Overview 32
5.2 Mental Health Clinical Coding Standards Refresher Course 35
5.2.1 Pre-requisite skills, knowledge and experience 35
5.2.2 Booking a place on the Mental Health Clinical Coding Standards Refresher Course
(MHCCSRC) 36

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5.2.3 Mental Health Clinical Coding Standards Refresher Course Details 37

5.2.3.1 Course Overview 37

6 Introduction to Classifications training 40

6.1 Pre-requisite skills, knowledge and experience 40
6.2 Booking a place on the Introduction to Classifications (ITC) Training 40
6.3 Introduction to Classifications Training Details 41
6.3.1 Training Overview 41

7 Other Useful Information 45

7.1 Clinical Coder Apprenticeship 45
7.2 Health Informatics 46
7.3 SNOMED CT Foundation Course 46
7.4 SNOMED CT Awareness for Clinical Coders 46
7.5 NHS Data Model and Dictionary 46

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1 Introduction
Guidance associated with Data Security and Protection Toolkit Standard 3 confirms that an
organisation must ensure that all its clinical coders are sufficiently trained so that they
maintain the highest standards of clinical coding. Training programmes for clinical coding
staff entering coded clinical data must be comprehensive and use material that conforms to
national clinical coding standards. The guidance further describes that novice clinical coders
begin to undertake formal Clinical Coding Standards Course or Mental Health Clinical
Coding Standards Course classroom training, as applicable, within six months of
commencing employment and that they attend Clinical Coding Standards Refresher Course
or Mental Health Clinical Coding Standards Refresher Course training, as applicable, every
three years thereafter. It also describes that the organisation should provide a training and
assessment framework which supports its clinical coders in gaining Accredited Clinical
Coder (ACC) status by passing the National Clinical Coding Qualification (UK) (NCCQ UK).
Please note: Any delay to training programmes during 2021/22 as a result of the ongoing
COVID-19 pandemic can be referenced as part of your organisation’s Data Security and
Protection Toolkit (DSPT) submission. We continue to provide the option of remote delivery
for those departments who are able and wish to take advantage – further information can be
found on the Clinical Coding Manager Workspace. Ultimately, if you would prefer to wait until
later in the year, when you/your staff will hopefully be able to access face to face classroom
training of national clinical coding training courses, then it is perfectly acceptable to do so.
This option is time-limited and subject to regular review during the COVID-19
pandemic.

The contents of the national clinical coding training programmes provide the necessary
training in the general and specialist knowledge and skills required to use the national clinical
coding standards for the following classifications used in everyday clinical coding within the
NHS:
• ICD-10: International Statistical Classification of Disease and Related Health
Problems 10th Revision– Fifth Edition (2016)
• OPCS-4: OPCS Classification of Interventions and Procedures Version 4.9 (April
2020).
The success of the training delivered depends upon the commitment and competence of the
individual and clear support from their clinical coding manager. It is therefore essential that
an individual and their organisation understand the base knowledge and skills required as
well as the ongoing commitment.
This Handbook provides the activities, roles and protocols which individually and collectively
ensure that standards associated with national clinical coding training are met.

1.1 Purpose of document

The document provides an outline for the mandatory national Clinical Coding Standards
Course (CCSC), Clinical Coding Standards Refresher Course (CCSRC), Mental Health
Clinical Coding Standards Course (MHCCSC), Mental Health Clinical Coding Standards
Refresher Course (MHCCSRC), and the NCCQ (UK) Revision Programme so that for each
course/programme the reader has a thorough understanding of:
• Pre-requisite skills, knowledge and experience

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• Content and format (pre-course, course, post-course)

• Benefits of national clinical coding training
• Delegate and line manager roles and responsibilities
• Ongoing requirements and Continued Professional Development (CPD) to maintain
clinical coding skills and work towards Accredited Clinical Coder (ACC) status.
1.1.1 Audience
Novice clinical coders recently employed in coding departments who need to develop the
required skills and knowledge to apply national clinical coding standards for the ICD-10 and
OPCS-4 classifications.
Experienced and accredited clinical coders needing to refresh and further develop their
existing skills and knowledge to apply national clinical coding standards for the ICD-10 and
OPCS-4 classifications.
Clinical coders who will be sitting the NCCQ (UK) examination who need to:
• understand the requirements and the framework for passing the exam
• refresh their skills and knowledge in applying national clinical coding standards for the
ICD-10 and OPCS-4 classifications
• gain a basic understanding of the uses, benefits and structure of SNOMED CT and
the differences between a Classification and SNOMED CT
• increase their knowledge of coding audit and wider coding areas on which the
questions in the miscellaneous section of the paper are based.
Line managers to understand the level of ongoing commitment required by the individual, the
line manager and the organisation to provide the necessary support for staff seeking to
become accredited clinical coders in the department to ensure robust data quality.
1.1.2 Background
Accurate and comprehensive coded clinical data is essential for reliable and effective clinical
and statistical analysis. A regular internal programme of clinical coding training ensures the
quality of coded clinical data to satisfy NHS regulatory bodies that organisations exemplify
best practice and promote a culture of continuous improvement.
The national clinical coding training courses/programmes support organisations by ensuring
the availability of the necessary training to promote highly qualified and skilled staff. The
CCSC, CCSRC, MHCCSC, MHCCSRC and NCCQ (UK) Revision Programme materials are
developed and maintained by the Terminology and Classifications Delivery Service – the
authoritative source of clinical classifications (ICD-10 and OPCS-4) and coding standards
that underpin the health, public health and social care systems by providing quality
information to support evidence-led care to patients and populations.
The content and format of the CCSC, CCSRC, MHCCSC, MHCCSRC and NCCQ (UK)
Revision Programme materials are developed in collaboration with approved clinical coding
trainers through the Clinical Coding Trainer Sub-Groups.

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2 Clinical Coding Standards Course

2.1 Pre-requisite skills, knowledge and experience
The Clinical Coding Standards Course (CCSC) pre-requisite criteria ensure that an applicant
has the base skills and knowledge required to become a clinical coder.
The CCSC is open to all staff already employed as a novice clinical coder in an NHS Trust
(including a Mental Health Trust) or an independent sector treatment centre (ISTC) which
treats, and codes consultant episodes for, NHS patients.

It is essential therefore, that applicants fulfil all of the following criteria prior to attending the
CCSC:
1. Have been employed as a clinical coder for between one-six months. Ideally, the
novice clinical coder will have been working within the department for a minimum
of six weeks before attending the course

2. Have a personal commitment to continued professional development including

completion of assessment-based learning in a variety of formats, e.g. classroom-
led learning, eLearning, self-learning and webinars

3. Have a structured training plan in place agreed with their line manager detailing
the time and resources available to complete all mandatory elements before,
during and after the course, as necessary

4. Have completed the following two mandatory eLearning courses prior to

attendance on the classroom CCSC

o Basic Anatomy and Physiology eLearning – all modules (Provides certificate /

screen print from End of Course Assessment)
o Basic Introduction to Clinical Coding – Modules 1 and 2 (Provides certificate /
screen print from End of Module Tests).

5. Have all the necessary up-to-date classifications books, reference

books/manuals, Chemotherapy Regimens List and associated Clinical Coding
Guidance documentation to bring with them to the classroom course either in hard
copy or electronic formats.

IMPORTANT INFORMATION:
Criteria 4 – Will be evidenced by provision of certificates.
Criteria 5 – The CCSC course trainer will email a Clinical Coding Reference Book/Manual
Download Confirmation Form template to the line manager before the course starts so that
the manager can confirm that their coder(s) has copies of all the necessary products for use
during the classroom-based course either in hard copy or electronic formats.
It is important that the applicant and line manager work together to ensure the
applicant meets all the criteria listed above.

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2.2 Booking a place on the Clinical Coding Standards

Course (CCSC)
As per guidance associated with Data Security and Protection Toolkit Standard 3, coding
managers must ensure that their novice clinical coder attends a classroom-based CCSC
within six months of commencing employment within their department.
CCSC training can be arranged/booked through one of the following options:
1. An in-house Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer within your own department
2. A Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer based within a neighbouring / other Trust
3. A commercial / independent Terminology and Classifications Delivery Service
approved apprentice or experienced clinical coding trainer.
NB: A register of approved clinical coding trainers who have given their permission for us to
publish their details is available on Delen
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training programme costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the CCSC course details (Section 2.3) for further information about pre-course,
course and post-course requirements.

2.3 Clinical Coding Standards Course Details

Course delegates and their line managers need to be aware of all the following content prior
to booking on to a course.
2.3.1 Course Overview
2.3.1.1 Mandatory pre-course eLearning
As referenced in Section 2.1, delegates must complete the following two mandatory
eLearning courses before attending the classroom element of the CCSC:
o Basic Anatomy and Physiology eLearning – all modules
o Basic Introduction to Clinical Coding – Modules 1 and 2
These eLearning courses are hosted on the Digital Learning Solutions platform and are
accessible via the Classifications eLearning page on Delen.
Delegates must read the relevant guidance document prior to attempting to access the
eLearning hosted on the Digital Learning Solutions platform. This document clearly explains
the need to select “NHS Digital Terminology and Classifications Delivery Service” from
the list of options at the “Centre” field when prompted to “Select your centre / organisation” . If
they select their own organisation, they will not be able to access our materials.

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There are 11 modules within the Basic Anatomy and Physiology eLearning package that the
novice coder must complete, including all the end of module and overall assessments.
Estimated time to complete this package is approximately four hours. A copy of the
delegate’s overall assessment results must be made available to the CCSC trainer prior to
attending the classroom course. The delegate and their line manager must therefore
factor in enough time before the classroom course for this to be done.
There are two modules within the ‘Basic Introduction to Clinical Coding’ eLearning package,
both of which require the delegate to complete a Workbook requiring sign-off by their line
manager. Each Workbook contains a number of activities. Some activities are to be done at
the delegate’s desk using the internet and other resources; some they need to find out
information from within their organisation. The Workbooks must be complete and taken with
the delegate to the first day of their Clinical Coding Standards Course; their trainer will ask to
see these. A copy of the delegate’s test results from each module must be made available to
the CCSC trainer prior to attending the classroom course. The delegate and their line
manager must therefore factor in enough time before the classroom course for this to
be done.
2.3.1.2 Course modules
This practical assessment-based course teaches recently appointed novice clinical coders
how to use their classification books and follow the four step coding process to ensure
correct application of ICD-10 and OPCS-4 national clinical coding standards and facilitate
accurate coded clinical data.
This course is delivered across four modules in no less than 21 days and no more than 25
days. The exact course length must be agreed in advance between the Approved Clinical
Coding Trainer and the delegate’s line manager depending on the needs of the delegate /
organisation. NB: The original plan to change the course duration to a minimum of 22
days from 1 April 2021 with the introduction of the mandatory one-day pre CCSC
‘Introduction to Classifications’ one day classroom module has been postponed (refer
to Section 6 for more information).
The four modules cover:
Module 1: Organisation and structure of ICD-10 and OPCS-4
Four Step Coding Process for ICD-10 and OPCS-4
Essential Coding Pointers
Several ICD-10 and OPCS-4 coding standards (general, chapter and coding)
Self-Learning Workbook Exercises*
Recap Exercise
Post Module written Assessment (practical and theory papers)
Module 2: Several ICD-10 and OPCS-4 coding standards (general, chapter and coding)
Case Studies
Self-Learning Workbook Exercises*
Recap Exercise
Post Module written Assessment (practical and theory sections)
Module 3: Several ICD-10 and OPCS-4 coding standards (general, chapter and coding)
Case Studies

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Self-Learning Workbook Exercises*

Recap Exercise
Post Module written Assessment (practical and theory sections)
Module 4: Several ICD-10 and OPCS-4 coding standards (general, chapter and coding)
Case Studies
Self-Learning Workbook Exercises*
Recap Exercise
Data Extraction
Post Module written Assessment (practical and theory sections)
End of Course Assessment
The content of Modules 2 and 3 and the ICD-10 and OPCS-4 chapter element of Module 4
can be delivered in any order. The timing of the modules is open for discussion between the
course trainer and the coding manager, e.g. one module each month for four consecutive
months, four modules delivered over eight weeks with a week’s gap in-between modules,
etc.
*The Self-Learning Workbook forms part of the Terminology and Classifications Delivery
Service Clinical Coding Standards Course (CCSC) materials. It is available in both the
current CCSC national training materials and on the Clinical Coding Managers Workspace
for optional use in the following two circumstances:
1. Supplied by the course trainer to those CCSC delegates who wish to learn more
about various diagnoses and procedures/interventions in-between course modules to
enhance their knowledge, understanding and research skills and provide them with
the opportunity to further develop self-confidence in their role as a clinical coder.
2. Supplied to novice clinical coders by their clinical coding manager to research various
medical terminology as part of their induction to the department to enhance their
knowledge and research skills and provide them with the opportunity to further
develop self-confidence in their role as a clinical coder.
Exercises can be completed at a pace that suits the individual either during work time or their
own time, depending on organisational requirements.
This document must not be used or copied for any purpose other than in the above
circumstances.
It is therefore essential that clinical coding managers discuss their preferred option with the
CCSC trainer before the start of the course.

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2.3.1.3 Benefits to the delegate

• Provides an optimal learning environment
• Gives access to highly experienced and skilled
Terminology and Classifications Delivery Service
approved clinical coding trainers
• Provides an understanding of the correct application of the national clinical coding
standards for both ICD-10 and OPCS-4
• Develops delegate confidence to accurately assign ICD-10/OPCS-4 codes when
back in the workplace, through practical activities and assessments throughout the
course
• Gives a greater understanding of the role and importance of clinical coding within the
delegate’s working environment
• Supports an ongoing record of continued professional development through regular
ongoing training
• Can provide an opportunity to network with clinical coders from other organisations.

2.3.1.4 Benefits to the organisation

• Elements of self-learning to instil research skills in the novice coder from the outset
• Set of rigorous objectives that delegates are assessed against to support
competence and confidence when back in the workplace
• Classroom delivery by a learner-focused approved clinical coding trainer who can
deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all novice clinical
coders
• Delivery by a skilled approved clinical coding trainer
who understands the need for accurate, high quality “The course was both
coded clinical data to support healthcare planning, informative and enjoyable -
reimbursement, management of services, statistical I really enjoyed the way it
analysis and research was taught through
presentations and lots of
• Increased effectiveness of formal training events and interactive exercises both
of learning transferred to the workplace through requiring me to work as an
ongoing online evaluation individual and with course
mates. There were lots of
• The opportunity to deliver a more cost-efficient in- opportunities to ask
house clinical coding training programme to satisfy questions and I found the
internal data quality, Data Security and Protection examples that we were
Toolkit Standard 3 and other NHS regulatory body coding to be really clear
and helpful to real-life
requirements.
problems in case notes.”
2.3.1.5 Attendance criteria
This course is only available to clinical coders employed
within an NHS Trust (including a Mental Health Trust, or an
independent sector treatment centre (ISTC) which treats, and codes consultant episodes for,
NHS patients).

By the end of Module 1 delegates will be able to:

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• Accurately assign ICD-10 5th Edition and OPCS-4 codes to at least 80% of questions
on the Post Module 1 Practical Assessment Paper
• Correctly write down the answers to at least 80% of the questions on the Post Module
1 Theory Assessment Paper.

By the end of Module 2 delegates will be able to:

• Score at least 85% by selecting the correct options for multiple choice questions and
writing the correct answers to the case study questions in the Theory elements of the
Post Module 2 Assessment Paper
• Accurately assign ICD-10 5th Edition and OPCS-4 codes to at least 85% of questions
in the Practical sections of the Post Module 2 Assessment Paper.

By the end of Module 3 delegates will be able to:

• Score at least 85% by selecting the correct options for multiple choice questions and
writing the correct answers to the case study questions in the Theory elements of the
Post Module 3 Assessment Paper
• Accurately assign ICD-10 5th Edition and OPCS-4 codes to at least 85% of questions
in the Practical sections of the Post Module 3 Assessment Paper.

By the end of Module 4 delegates will be able to:

• Score at least 85% by selecting the correct options for multiple choice questions and
writing the correct answers to the case study questions in the Theory elements of the
Post Module 4 Assessment Paper
• Accurately assign ICD-10 5th Edition and OPCS-4 codes to at least 85% of questions
in the Practical sections of the Post Module 4 Assessment Paper.

By the end of the Clinical Coding Standards Course, delegates will be able to:
• Score at least 85% by selecting the correct options for the given multiple choice and
missing words questions and writing the correct answers to the case study questions
in the Theory elements of the End of Course Assessment Paper
• Accurately assign ICD-10 5th Edition and OPCS-4 codes to at least 85% in the
Practical Case Study section of the End of Course Assessment Paper.

Delegates and line managers need to be aware in advance what the course and module
objectives are so that they understand the time and effort required to meet the objectives.
Delegates are required to:

• Complete a number of exercises in their Self-Learning Workbook throughout the

course and in-between modules, if this option is agreed between the course trainer
and clinical coding manager
• Successfully complete written theory and practical assessments at the end of each
module and an overall course assessment
• Successfully complete any Interim Attendance Development Plans when a delegate is
unable to attend any part (i.e. session, day or module) of the course for whatever
reason(s)
• Successfully complete any Development Plan Agreements within agreed timescales
where an individual does not meet any of the module and/or course objectives.

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Where Development Plan Agreements are required, the trainer, the delegate and the
delegate’s line manager must agree on the appropriate course of action, timeframes, how
the Development Plan will be checked and by whom.

The delegate will only receive a Certificate of Successful Completion when they fully
evidence they have met all the module and course objectives for the Clinical Coding
Standards Course. Certificates will therefore only be issued on successful completion of
Development Plans where these are required.

2.3.1.6 What will the course cover?

Using classification books and reference products
• Learning about the organisation and structure of ICD-10 Volumes 1, 2 and 3
• Learning about the organisation and structure of OPCS-4 Volumes I and II
• Using each step of the Four Step Coding Process to correctly assign ICD-10 and
OPCS-4 codes
• Navigating the National Clinical Coding Standards ICD-10 5th Edition and OPCS-4
reference books to locate national clinical coding standards
• Using the Coding Clinic
• Understanding the structure and content of the OPCS-4 Chemotherapy Regimens List
• Learning how to use the Chemotherapy Regimens Clinical Coding Standards and
Guidance OPCS-4 document
Applying national clinical coding standards
• Completing quick-fire scenarios and more detailed case studies to correctly assign
ICD-10 and OPCS-4 codes for all ICD-10 and OPCS-4 chapters
• Completing recap exercises and other activities to reinforce the practical and
theoretical aspects of national clinical coding standards for ICD-10 and OPCS-4
• Using all available reference products to support accurate code assignment.
Data extraction and research
• Undertaking basic internet searches to research various illnesses and interventions
• Selecting all relevant conditions, circumstances and interventions to be coded by
following basic data extraction guidance and reviewing sample source documentation.
Monitoring and assessment
• Completing regular practical and theoretical assessments to monitor personal
progress
• Identifying areas for further development where necessary.
Time management
• Completing self-learning, individual exercises, assessments, development plans
(where required), and group activities to required deadlines.

Ongoing requirements
• Mandatory Clinical Coding Standards Refresher Course training
• Working towards accredited clinical coder (ACC) status.

2.3.1.7 Course Materials

Each delegate receives:
• Delegate course folder
• Written Exercises and Answer sheets
• Reference Handouts

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• ICD-10 and OPCS-4 Exercise and Answer Booklets

• Self-Learning Workbook Template (if the option to complete as part of the CCSC is
chosen)
• Individual Course Record of Assessment / performance report
• Certificate of Successful Completion.

2.3.1.8 Reference Materials

Important information
The delegate’s line manager must supply their delegate with a copy of the following in either
hard copy or electronic format for use during the course:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)*
• OPCS-4.9 Volumes I and II*
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)**
• National Clinical Coding Standards OPCS-4 reference book (2021)**
• Basic Anatomy and Physiology Instruction Manual (2020)**
• Supplementary Information Booklet OPCS-4.9**
• National Tariff Chemotherapy Regimens List**
• Chemotherapy Regimens Clinical Coding Standards and Guidance OPCS-4**
NB: All classification books highlighted with an * should preferably be new and not passed
down from previous users as this can cause confusion for novice coders. ICD-10 5th Edition
books can be purchased from The Stationery Office via
https://www.tsoshop.co.uk/bookstore.asp?FO=1160643&DI=643306
To order OPCS-4.9 books, follow the link on Delen at
https://hscic.kahootz.com/gf2.ti/f/762498/58563845.1/PDF/-
/OPCS_4.9_Vol_I_and_II_NHS_digital_2020.pdf
NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an **. These can be found within the ICD-10, OPCS-4 and Other
sections on the Popular Publications area on Delen.
Delegates may also use the OPCS-4.9 e-Version and ICD-10 5th Edition e-Version*. These
products can be downloaded via Delen. The online Classifications Browser is also available
Coding Clinic Ref 88: Coding of Co-morbidities
Coding Clinic Ref 121: Procedures performed for female pelvic organ prolapse and stress
urinary incontinence
NB: Delegates can download the latest version of the Coding Clinic onto their laptops/tablets
if desired from the Publications & Resources area on Delen.

2.3.1.9 Course Timings

The course timings will be provided by the course trainer.

2.3.1.10 Delegate Responsibilities – Summary

The delegate is responsible for:
• Ensuring punctuality at all times
• Respecting the course trainer and fellow delegates

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• Attending all modules of the Clinical Coding Standards Course

• Completing and evidencing all mandatory pre-course eLearning prior to the classroom
training
• Completing all Self-Learning Workbook exercises during the course to the timeframes
instructed by the course trainer where this is being used as part of the CCSC
• Completing all assessments to the required criteria
• Completing all necessary Development Plans to the required criteria and timeframes
supplied by the course trainer.

2.3.1.11 Line Manager Responsibilities – Summary

The line manager is responsible for:
• Ensuring their novice coder attends a CCSC within six months of employment
• Providing clean copies of all reference products described in Section 2.3.1.8 above
• Providing ongoing support to the delegate to ensure sufficient time and resources are
available for completion of the two mandatory eLearning packages before the
classroom course, all modules of the course including time to complete Self-Learning
exercises in-between modules (where the Self-Learning Workbook is being used as
part of the CCSC)
• Discussing with the course trainer appropriate Development Plan Agreements and
timeframes during the course and/or after the course where necessary, and providing
ongoing support for the delegate to complete these.

2.3.1.12 Next Steps

Successful completion will result in compliance with Data Security and Protection Toolkit
Standard 3, Level: Standards Met.

3 Clinical Coding Standards Refresher Course

3.1 Pre-requisite skills, knowledge and experience
The Clinical Coding Standards Refresher Course pre-requisite criteria ensure that an
applicant has the ongoing skills and knowledge required by a clinical coder.
The CCSRC is open to all staff already employed as a clinical coder in an NHS Trust
(including a Mental Health Trust), or an independent sector treatment centre (ISTC) which
treats, and codes consultant episodes, for NHS patients.

Clinical coders must attend a Clinical Coding Standards Refresher Course once every 3
years from their successful completion of a Clinical Coding Standards Course.

It is essential therefore, that applicants fulfil all of the following criteria prior to attending the
CCSRC:
1. Have been employed as a clinical coder for 2-3 years before attending their first
CCSRC

2. Have attended a CCSRC three years ago (where applicable) (Provides previous
course certificate)

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3. Have a personal commitment to continued professional development including

completion of assessment-based learning in a variety of formats, e.g. classroom-
led learning, eLearning, self-learning, webinars

4. Have a structured training plan in place agreed with their line manager detailing
the time and resources available to complete all mandatory elements before,
during and after the course, as necessary

5. Have completed the following mandatory eLearning course prior to attendance on

the classroom CCSRC:

o Four Step Coding Process ICD-10 eLearning – all modules (Provides line
manager email confirmation / screen print / certificate from End of Course
Assessment)

6. Have completed and returned the pre-course questionnaire within the timeframe
set by the trainer prior to the course start date to allow for adequate trainer
preparation

7. Have all the necessary up-to-date classification books, reference books/manuals,

Chemotherapy Regimens List and associated Clinical Coding Guidance
documentation to bring with them to the classroom course either in hard copy or
electronic formats.

IMPORTANT INFORMATION:
Criteria 2 and 5 – Will be evidenced by provision of confirmation email / screen print /
certificate.
Criteria 6 – Will be evidenced by completion of the pre-course questionnaire.
Criteria 7 – Will be evidenced by line manager completion of the Clinical Coding Reference
Book/Manual Download Confirmation Form template to the Course Trainer before the course
starts so that the manager can confirm that their coder(s) has copies of all the necessary
products for use during the classroom-based course either in hard copy or electronic
formats.
It is important that the applicant and line manager work together to ensure the
delegate meets all the criteria listed above.

3.2 Booking a place on the Clinical Coding Standards

Refresher Course (CCSRC)
As per guidance associated with Data Security and Protection Toolkit Standard 3, coding
managers must ensure that their clinical coder attends CCSRC training every 3 years.
CCSRC training can be arranged/booked through one of the following options:
1. An in-house Terminology and Classifications Delivery Service approved experienced
clinical coding trainer within your own department

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2. A Terminology and Classifications Delivery Service approved experienced clinical

coding trainer based within a neighbouring / other Trust
3. A Commercial / Independent Terminology and Classifications Delivery Service
Approved experienced clinical coding trainer.
NB: A list of approved clinical coding trainers who have given their permission for us to
publish their details is available using the search facility on Delen.
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training course costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the CCSRC course details (Section 3.3) for further information about pre-course,
course and post-course requirements.

3.3 Clinical Coding Standards Refresher Course Details

Course delegates and their line managers need to be aware of all the following content prior
to booking on to a course.
3.3.1 Course Overview
This practical assessment-based course is fundamental to the continued professional
development of all experienced clinical coders by assessing that they are keeping their
practical coding skills and theoretical knowledge up-to-date for the ICD-10 and OPCS-4
clinical classifications and associated updates. The course also provides experienced clinical
coders with the opportunity to reinforce the four step coding process to ensure correct
application of ICD-10 and OPCS-4 national clinical coding standards to facilitate accurate
coded clinical data.
This course is delivered across four days in a classroom environment. However, this course
can be delivered online by approved trainers who have our permission to deliver national
training courses online.
3.3.1.1 Mandatory pre-course eLearning and questionnaire
As referenced in Section 3.1, delegates must complete the following mandatory eLearning
course hosted on the Digital Learning Solutions platform and accessible via Delen before
attending the classroom element of the CCSRC:
o Four Step Coding Process ICD-10 eLearning – all 7 modules
Estimated time to complete this package is approximately 1.5 hours. The delegate and their
line manager must therefore factor in enough time before the classroom course for
this to be done.
Delegates must read the relevant guidance document prior to attempting to access the
eLearning hosted on the Digital Learning Solutions platform. This document clearly explains

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the need to select “NHS Digital Terminology and Classifications Delivery Service” from
the list of options at the “Centre” field when prompted to “Select your centre / organisation” . If
they select their own organisation, they will not be able to access our materials.
Prior to the course starting, the course trainer will email the CCSRC pre-course
questionnaire which must be completed by the delegate and returned to the course trainer
within the given timeframe to allow for adequate trainer preparation. This will help ensure the
course meets both the needs of the delegates and the organisation. The trainer will aim to
cover any areas of concern/problems time permitting; however this is not the correct
forum for discussing individual clinical coding queries. These must be submitted using
the National Clinical Coding Query Mechanism explained on Delen.

3.3.1.2 Benefits to the delegate

• Provides an optimal learning environment

• Gives access to highly experienced and skilled

Terminology and Classifications Delivery Service
approved clinical coding trainers

• Provides reinforcement of the correct application of the national clinical coding

training standards for both ICD-10 and OPCS-4
“Given
• Opportunity to refresh and consolidate existing practical coding skills for ICD-10 clinica
and OPCS-4 amen
• Opportunity to refresh and consolidate existing theoretical coding knowledge for course
ICD-10 and OPCS-4 reinfo
previo
• Opportunity to apply this knowledge to consistently and accurately identify the also fi
correct ICD-10 and OPCS-4 codes for a range of typical case note and more where
complex scenarios updat
• Opportunity to share clinical coding experiences and best practice with fellow recom
my co
delegates
becau
• Opportunity to refresh and consolidate existing medical terminology and anatomy compu
and physiology knowledge helps
to dat
• Identifies any areas for further development
standa
• Increases delegate confidence to accurately code when back in the workplace,
through practical activities, group discussions and assessments throughout the
course
• Supports an ongoing record of continued professional development through
regular ongoing training
• Can provide an opportunity to network with experienced
clinical coders from other organisations.
“The course was fantastic,
it covered all areas that I
3.3.1.3 Benefits to the organisation felt I needed to work on. I
• Set of rigorous objectives that delegates are assessed strongly recommend it to
other coders.”
against to support ongoing competence and confidence
when back in the workplace
• A blended learning approach to reinforcing national
clinical coding standards

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• Classroom delivery by a learner-focused approved clinical coding trainer who can

deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all experienced clinical coders
• Delivery by a skilled approved clinical coding trainer who understands the need for
accurate, high quality coded clinical data to support healthcare planning,
reimbursement, management of services, statistical analysis and research
• Increased effectiveness of formal training events and of learning transferred to the
workplace through ongoing online evaluation
• The opportunity to deliver a more cost-efficient in-house clinical coding training
programme to satisfy internal data quality, Data Security and Protection Toolkit
Standard 3 and other NHS regulatory body requirements.

3.3.1.4 Attendance criteria

This course is only available to experienced clinical coders employed within an NHS Trust
(including a Mental Health Trust), or an independent sector treatment centre (ISTC) which
treats and codes consultant episodes for NHS patients.

By the end of the course delegates will be able to:

• Select the correct option for at least 17 of the 20 (85%) given multiple choice
questions, using your reference books.
• Correctly assign ICD-10 and OPCS-4 codes to six case studies to at least 85%
accuracy.
Delegates and line managers need to be aware in advance of the course objectives so that
they understand the time and effort required to meet the objectives. Delegates are required
to:

• Complete a number of exercises throughout the course

• Successfully complete written theory and practical assessments at the end of the
course. NB: The practical assessment involves completion of four mandatory case
studies and then two further case studies from a choice of six
• Successfully complete any Interim Attendance Development Plans when a delegate is
unable to attend any part (i.e. session or day) of the course for whatever reason(s)
• Successfully complete any Development Plan Agreements within agreed timescales
where an individual does not meet any of the course objectives.

Where Development Plan Agreements are required, the trainer, the delegate and the
delegate’s line manager must agree on the appropriate course of action, timeframes, how
the Development Plan will be checked and by whom.

The delegate will only receive a Certificate of Successful Completion when they fully
evidence they have met all the course objectives for the Clinical Coding Standards
Refresher Course. Certificates will therefore only be issued on successful completion of
Development Plans where these are required.

3.3.1.5 What will the course cover?

Reinforcement of the four step coding process
• Using each step of the Four Step Coding Process to correctly assign ICD-10 and
OPCS-4 codes

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Applying national clinical coding standards

• Completing quick-fire scenarios and more detailed case studies to correctly assign
ICD-10 and OPCS-4 codes
• Completing other individual and group activities to reinforce the practical and
theoretical aspects of national clinical coding standards for ICD-10 and OPCS-4
• Using all available reference products to support accurate code assignment
Maintaining data extraction skills
• Selecting all relevant conditions, circumstances and interventions to be coded in
realistic case studies by following general coding standards
Monitoring and assessment
• Completing practical and theoretical end of course assessments to monitor personal
progress
• Identifying areas for further development where necessary
Time management
• Completing individual exercises, assessments, development plans (where required),
and group activities to required deadlines
Ongoing requirements
• Mandatory three-yearly Clinical Coding Standards Refresher Course training
• Specialty workshops
• Accredited clinical coder status (where still required)

3.3.1.6 Course Materials

Each delegate receives:
• Delegate course folder
• Participant’s Workbook and Answer Book
• Reference Handouts
• Individual Course Record of Assessment / performance report
• Certificate of Successful Completion.

3.3.1.7 Reference Materials

The delegate’s line manager must ensure their delegate has a copy (either hard copy or
electronic format) of the following for use during the course:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)
• OPCS-4.9 Volumes I and II
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)*
• National Clinical Coding Standards OPCS-4 reference book (2021)*
• National Tariff Chemotherapy Regimens List*
• Chemotherapy Regimens Clinical Coding Standards and Guidance OPCS-4*
NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an *. These can be found within the ICD-10, OPCS-4 and Other
sections on the Publications & Resources area on Delen.
Delegates may also use the OPCS-4.9 e-Version and ICD-10 e-Version*. These products
can also be downloaded via Delen. The online Classifications Browser is also available
Coding Clinic Ref 88: Coding of Co-morbidities

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Coding Clinic Ref 121: Procedures performed for female pelvic organ prolapse and stress
urinary incontinence
NB: Delegates can download the latest version of the Coding Clinic onto their laptops/tablets
if desired. This can be found on the Key Publications page on Delen.
3.3.1.8 Course Timings
The course timings are:
Day 1: 09.00 – 17.00
Day 2: 09.00 – 16.45
Day 3: 09.00 – 16.45
Day 4: 09.00 – 16.30

3.3.1.9 Delegate Responsibilities – Summary

The delegate is responsible for:
• Ensuring punctuality at all time
• Respecting the course trainer and fellow delegates
• Attending all days of the Clinical Coding Standards Refresher Course
• Completing and evidencing all mandatory pre-course eLearning prior to the classroom
training
• Completing all assessments to the required criteria
• Completing all necessary Development Plans to the required criteria and timeframes
supplied by the course trainer.

3.3.1.10 Line Manager Responsibilities – Summary

The line manager is responsible for:
• Ensuring their clinical coder completes a CCSRC every 3 years
• Ensuring availability of all reference products described in Section 3.3.1.7 above
• Providing ongoing support to the delegate to ensure sufficient time and resources are
available for completion of the mandatory eLearning package before the classroom
course
• Discussing with the course trainer appropriate Development Plan Agreements and
timeframes during the course and/or after the course where necessary, and providing
ongoing support for the delegate to complete these.

3.3.1.11 Next Steps

Successful completion will result in compliance with Data Security and Protection Toolkit
Standard 3 – Level: Standards Met.

4 NCCQ (UK) Revision Programme

This Programme has a modular format (Modules 1, 2 and 3) delivered in a minimum of four
days over a recommended (not mandatory) five-to-six-month period. Its content and format
have been designed to better support candidates studying for the National Clinical Coding
Qualification (UK). The Programme aims to:

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• Structure delegate revision time effectively using the recommended study guidelines
and the revision materials provided, in time to sit the National Clinical Coding
Qualification (UK).
• Assist the delegate to research broader issues connected to clinical coding including
uses of coded data, clinical coding audit, examples of ICD supplementary
classifications and several more.
• Assist the delegate to develop a basic understanding/awareness of SNOMED CT.
• Allow the delegate to discuss areas of uncertainty with the programme trainer(s) and
fellow delegates.
• Assess delegate current knowledge of national coding standards, anatomy and
physiology and medical terminology and identify any areas of weakness by sitting a
mock exam(s) under examination conditions.

4.1 Pre-requisite skills, knowledge and experience

In order to achieve the high level of attainment required for the qualification, a clinical coder
must typically have undertaken a 2-3 year development plan with their employer to complete
the required national standard clinical coding training, acquire the breadth of skills,
knowledge and practical work experience to become competent in clinical coding and be
ready to sit the examination papers.
As part of this development plan a clinical coder will need to complete the national Clinical
Coding Standards Course (CCSC) and preferably the national Clinical Coding Standards
Refresher Course (CCSRC) before attending the NCCQ (UK) Revision Programme.
This Programme is also open to coders needing to re-sit Paper 1, Paper 2, or both papers of
the National Clinical Coding Qualification (UK).
4.1.1 Mandatory Pre-requisites
Before attending the NCCQ (UK) Revision Programme, attendees must have read the
following documents/or attended the stated course. All documents are available on the
National Clinical Coding Qualification (UK) page on Delen.
Mandatory Pre-requisite
NCCQ (UK) 2021-22 Syllabus, Framework, Bibliography
NCCQ (UK) Self-directed Learning Framework 2021-22
NCCQ (UK) September 2019 Revision Aid
Clinical Coding Standards Course (21-25 days)

4.1.2 Desirable Pre-requisites

The following activities are advisable to complete / review before attending the NCCQ (UK)
Revision Programme as they will give the attendee a better understanding of the contents
covered by the approved clinical coding trainer(s) delivering the classroom modules.
Desirable Pre-requisite
SNOMED CT Education and Training Delen including:

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Reviewed the content on the SNOMED CT to Classification Maps

page on Delen
Reviewed the SNOMED CT Awareness for Clinical Coders
presentation available on Delen
Four Step Coding Process ICD-10 elearning module**
Basic Introduction to Clinical Coding elearning module**
Anatomy and Physiology elearning module**
Clinical Coding Standards Refresher Course
Speciality Clinical Coding Workshops

* Please see SNOMED CT animations as an alternative.

** Accessible via Delen
In addition applicants must have:
1. A personal commitment to continued professional development and study including
completion of a number of activities in a variety of formats, e.g. classroom-led
revision, eLearning and self-learning / study.
2. The necessary up-to-date classification books, reference books/manuals,
Chemotherapy Regimens List and associated Clinical Coding Guidance
documentation to bring with them to the classroom course either in hard copy or
electronic formats.
IMPORTANT INFORMATION:
Mandatory Pre-requisite criteria – Will be evidenced by completion of the NCCQ (UK)
Revision Programme Pre-Information and Pre-Requisites form.
Desirable criteria – Will be evidenced where applicable by completion of the NCCQ (UK)
Revision Programme Pre-Information and Pre-Requisites form.
Criteria 2 – Will be evidenced by line manager completion of the Clinical Coding Reference
Book/Manual Download Confirmation Form template to the Programme trainer before the
Programme starts so that the manager can confirm that their coder(s) has copies of all the
necessary products for use during the classroom-based modules either in hard copy or
electronic formats.
It is important that the applicant and Line Manager work together to ensure the
applicant meets all of the criteria listed above.

4.2 Booking a place on the NCCQ (UK) Revision

Programme
As per guidance associated with Data Security and Protection Toolkit Standard 3,
organisations should provide a training and assessment framework which supports its
clinical coders in gaining Accredited Clinical Coder (ACC) status by passing the National
Clinical Coding Qualification (UK).
NCCQ (UK) Revision Programme training can be arranged/booked through one of the
following options:

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1. An in-house Terminology and Classifications Delivery Service approved experienced

clinical coding trainer within your own department
2. A Terminology and Classifications Delivery Service approved experienced clinical
coding trainer based within a neighbouring / other Trust
3. A commercial / independent Terminology and Classifications Delivery Service
approved experienced clinical coding trainer.
NB: A list of approved clinical coding trainers who have given us their permission to publish
their details is available on Delen.
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training programme costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the NCCQ (UK) Revision Programme details (Section 4.3) for further information
about pre-programme, programme and post-programme requirements.

4.3 NCCQ (UK) Revision Programme Details

Programme delegates and their line managers need to be aware of all the following content
prior to booking on to the programme.
4.3.1. Programme Overview
This programme is a modular one designed primarily to support coders to pass the National
Clinical Coding Qualification (UK) through classroom-led revision and structured revision
workbooks to support ongoing self-directed study. It includes mock examination papers that
delegates sit under examination conditions.
This programme is delivered in a minimum of four days across three separate modules.
Trainers can extend the length of this programme to suit the requirements of their delegates
and their employing organisations, for example, by extending Module 1 to two days,
incorporating delivery of a four day Clinical Coding Standards Refresher Course in-between
Modules 2 and 3.
4.3.1.1. Pre-Information and Mandatory Pre-Requisites
All delegates must complete the NCCQ (UK) Revision Programme Pre-Information and Pre-
Requisites form emailed to them by the programme trainer by the required deadline.
All line managers must complete the Clinical Coding Reference Book/Manual Download
Confirmation Form template and email back to the programme trainer before the programme
starts.
4.3.1.2 Programme Modules
This revision focused programme reinforces to delegates how to use their classification
books and the Four Step Coding Process to ensure correct application of ICD-10 and OPCS-
4 national clinical coding standards to help them pass the National Clinical Coding
Qualification (UK).

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With the exception of re-sit candidates, all delegates must attend all three Modules which
cover the following content:
Module 1 (One-two days in length to be delivered ideally 4-5 months before the exam
date):
Pre Exam Study Day 1
• Discussions / responses to questions about the
o Study Guide
o Bibliography
o Syllabus
• Issue the Self-Learning Workbook on Miscellaneous issues
• SNOMED CT
• Data Extraction
• Consolidate the learning around
o A&P and Medical Terminology
o Organisation and Structure of ICD-10 and OPCS-4
o Four Step Coding Process
• Issue the list of available Revision documents
• Confirm availability of the ICD-10 and OPCS-4 Exercise Booklets

Module 2 (Days 2 and 3 to be delivered ideally 3 months before the exam date):
Day 2 a.m.
• Consolidate the learning in the form of exam style questions and discussions around:
o Miscellaneous Issues (Self-Learning workbook content)
o SNOMED CT
o A&P and Medical Terminology

Day 2 p.m.
• ICD-10 KLPs
o Presentations (additional chapters)
o Activities and Exercises

Day 3 a.m.
• OPCS-4 KLPs
o Presentations (additional chapters)
o Activities and Exercises

Day 3 p.m.
• Clarification of Grey Areas
• Exam style questions/discussions
• Activities and Exercises
• Discussion Case Studies

Module 3 (Day 4 to be delivered ideally 1 month before the exam date):

• Exam Techniques
• Exam paper layout and language used
• What is allowed to be written/annotated in both classifications
• What can be taken into the examination room on the day
• Sit Mock Exam Papers (Practical and Theory)

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• Feedback within 10 days of course end date

Timing of the modules is key to support candidates during their revision.

4.3.1.3 Benefits to the delegate

• Provides an optimal revision environment
• Gives access to highly experienced and skilled Terminology and Classifications
Delivery Service approved clinical coding trainers
• Provides reinforcement of the correct application of the national clinical coding
standards for both ICD-10 and OPCS-4
• Opportunity to refresh and consolidate existing practical coding skills for ICD-10 and
OPCS-4
• Opportunity to refresh and consolidate existing theoretical coding skills for ICD-10 and
OPCS-4
• Opportunity to refresh and consolidate existing medical terminology and anatomy and
physiology knowledge
• Opportunity to refresh and consolidate existing knowledge on miscellaneous issues
such as SNOMED CT, uses of coded data, clinical coding audit, supplementary
classifications, National Tariff Payment System
• Provides guidance on developing a structured study plan to suit individual needs
• Provides the delegate with the opportunity to access comprehensive revision
workbooks covering all elements of the National Clinical Coding Qualification (UK)
• Identifies any areas for further delegate revision
• Increases delegate confidence to sit the National Clinical Coding Qualification (UK)
through mock examinations, practical activities, group discussions and ongoing
revision support throughout the programme
• Can provide an opportunity to network with experience clinical coders from other
organisations who have the same objective to become accredited clinical coders.
4.3.1.4 Benefits to the organisation
• Set of rigorous objectives that delegates are assessed against to support their
revision for the National Clinical Coding Qualification (UK)
• A blended approach to revision reinforcing all elements that could be included in the
National Clinical Coding Qualification (UK)
• Classroom-led revision by a learner-focused approved clinical coding trainer who can
deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all experienced clinical coders
• Delivery / facilitation by a skilled approved clinical coding trainer who understands the
need for continued professional development and accreditation for the profession and
the need for accurate, high quality coded clinical data to support healthcare planning,
reimbursement, management of services, statistical analysis and research
• Increased effectiveness of formal training events and of learning transferred to the
workplace through ongoing online evaluation

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• The opportunity to deliver a more cost-efficient in-house revision programme to satisfy

internal data quality, Data Security and Protection Standard 3, Clinical Governance
and other NHS regulatory body requirements.
4.3.1.5 Attendance Criteria
This programme is only available to experienced clinical coders employed within an NHS
Trust (including a Mental Health Trust) or an independent sector treatment centre (ISTC)
which treats, and codes consultant episodes for, NHS patients.
By the end of Module 1 of the programme delegates will be able to:
• Draft an outline study plan using the template provided if they haven’t already created
a study plan.
• From memory, list five references found in the Bibliography that can support a NCCQ
(UK) Candidate study for Paper 1 – Practical Coding.
• From memory, list three references found in the Bibliography that can support a
NCCQ (UK) Candidate study for Paper 2 – Theory.
• Correctly match the A&P statement to the correct body part/area for at least 9 out of
11 statements in the given exercise.
• Correctly match the types of classification map, with their associated description and
example in the given card matching exercise, without reference to your notes.
OR
• List at least 5 different benefits of both SNOMED CT and the ICD-10/OPCS-4
classifications in the given flipchart activity and feedback to the rest of the delegates.
• Correctly answer 2 out of the 3 given SNOMED CT questions with minimal reference
to notes.
• Score a minimum of 95% in both the ICD-10 and OPCS-4 Organisation and Structure
exercises with reference to the National Clinical Coding Standards ICD-10 5th Edition
and OPCS-4 reference books only where essential.
• Correctly answer all questions in the ICD-10 and OPCS-4 Four Step Coding Process
exercises using their Alphabetical Indexes and Tabular Lists.
By the end of Module 2 of the Programme delegates will be able to:
• Select the correct option to at least 6 of the multiple-choice miscellaneous issues
questions with minimum reference to notes.
• Complete SNOMED CT, Anatomy and Physiology, Medical Terminology and ICD-10
and OPCS-4 theory questions to at least 60% accuracy.
• Assign ICD-10 and OPCS-4 codes to the practical questions to at least 90%
accuracy.
• Discuss accurate code assignment to the four given case studies as a group.
• Score at least 90% in the given case study using your ICD-10 and OPCS-4
Alphabetical Index and Tabular Lists only.
By the end of Module 3 of the Programme delegates will be able to:
• Assign ICD-10 and OPCS-4 codes to the questions in the Practical Mock Exam to at
least 90% accuracy.

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• Complete SNOMED CT, Anatomy and Physiology, Medical Terminology and ICD-10
and OPCS-4 theory questions in the Theory Mock Exam to at least 60% accuracy.
• Correctly write down the answers to all 10 of the given questions about the
Examination Day.
Delegates and line managers need to be aware in advance of the programme that ongoing
personal study is required in-between modules; this includes using the available revision
workbooks and completion of the self-learning workbook using the website links provided
before undertaking Module 2. This will prepare the delegate to answer questions in the
Miscellaneous Issues section in Module 2 of the NCCQ (UK) Revision Programme and in
Paper 2 of the actual National Clinical Coding Qualification (UK).
The delegate will receive a Certificate of Successful Completion when they fully evidence
they have met all the objectives for the NCCQ (UK) Revision Programme. NB: Certificates of
Completion will be issued on a modular basis to those delegates only sitting certain modules,
e.g. re-sit candidates.
4.3.1.6 What will the course cover?
Reinforcement of the importance of self-directed study
• Using the National Clinical Coding Qualification (UK) syllabus, framework and
bibliography and self-directed learning documents to populate a structured individual
study plan
Reinforcement of the four step coding process
• Using each step of the Four Step Coding Process to correctly assign ICD-10 and
OPCS-4 codes
Reinforcement of the organisation and structure of the classifications
• Completing short and longer style examination questions about the organisation and
structure of ICD-10 and OPCS-4
Applying national clinical coding standards
• Completing quick fire and case study scenarios in the exercises provided and in the
current version of the ICD-10 and OPCS-4 Exercise Booklets (and Answer Booklets)
available on request from [email protected]
Maintaining data extraction skills
• Selecting all relevant conditions, circumstances and interventions to be coded in case
studies by following national clinical coding standards
Monitoring and assessment
• Completing mock examination(s)
• Identifying areas for further revision where necessary
Time management
• Completing elements of the individual study plan to stated timeframes
• Sitting the mock examination paper(s) in examination conditions
Ongoing requirements
• Mandatory three-yearly Clinical Coding Standards Refresher Course training

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• Specialty workshops
• Approved Clinical Coding Trainer and/or Approved Clinical Coding Auditor (where
desired)
4.3.1.7. Programme Materials
Each delegate receives:
• Delegate Programme folder
• Reference Handouts
• Self-Learning Workbook
• Anatomy and Physiology Workbook (and Answer Book)*
• Anatomy and Physiology Diagrams Slide Deck*
• NCCQ (UK) Revision Workbook (and Answer Book)*
• SNOMED CT Workbook (and Answer Book)*
• Numerous additional revision aids
• Mock examination feedback report
• Certificate of Successful Completion
*These documents are available to examination candidates on request and only if they would
like them due to previous feedback that receiving all these documents in Module 1 was
overwhelming.
4.3.1.8. Reference Materials
The delegate’s line manager must ensure their delegate has a copy of the following (either in
hard copy or electronic format) for use during the NCCQ (UK) Revision Programme and
ongoing study:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)
• OPCS-4.9 Volumes I and II
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)*
• National Clinical Coding Standards OPCS-4 reference book (2021)*
• OPCS-4.9 Supplementary Information Book*
• National Tariff Chemotherapy Regimens List*
• Chemotherapy Regimens Clinical Coding Standards and Guidance OPCS-4*
• Basic Anatomy and Physiology Instruction Manual (2020)*
NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an * during the Programme. These can be found within the ICD-10,
OPCS-4 and Other sections on the Publications & Resources area on Delen
Delegates may also use the OPCS-4.9 e-Version and ICD-10 e-Version*. These products
can also be downloaded via Delen. The online Classifications Browser is also available.
Coding Clinic Ref 88: Coding of Co-morbidities
Coding Clinic Ref 121: Procedures performed for female pelvic organ prolapse and stress
urinary incontinence

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NB: Delegates can download the latest version of the Coding Clinic onto their laptops/tablets
if desired. This can be found on the Key Publications page on Delen
4.3.1.9. Course Timings
The course timings are:
Module 1 (Day 1): 09.00 – 16.45
Module 1 (Day 2): Optional so times may vary
Module 2 (Day 2): 09.00 – 16.45
Module 2 (Day 3): 09.00 – 16.45
Module 3 (Day 4): 09.00 – 15.45
4.3.1.10. Delegate Responsibilities – Summary
The delegate is responsible for:
• Ensuring punctuality at all time
• Respecting the programme trainer and fellow delegates
• Attending the Modules applicable to their individual examination requirements
• Completing the NCCQ (UK) Revision Programme Pre-Information and Pre-requisites
form and emailing to the programme trainer by the required timeframe
• Completing the Self-Learning Workbook before Module 2
• Working through their individual study plan using the revision aids available and
according to the timeframes identified in their study plan.
4.3.1.11. Line Manager Responsibilities – Summary
The line manager is responsible for:
• Ensuring their clinical coder is fully supported during the 5 to 6-month revision
programme (including self-study) by allowing them the time to complete all relevant
Modules and personal study time in-between modules
• Ensuring availability of all reference products described in Section 4.3.1.8 above
• Providing ongoing support to their clinical coder to ensure sufficient time and
resources are available for completion of the desirable eLearning packages where
needed as part of their revision
• Allowing time for their clinical coder to attend any relevant Webinars.
4.3.1.12. Next Steps
Successful completion will result in compliance with Data Security and Protection Toolkit
Standard 3.

5 Mental Health Clinical Coding Training

Currently a dedicated 3-day Mental Health Clinical Coding Standards Course (MHCCSC)
and one-day Mental Health Clinical Coding Standards Refresher Course (MHCCSRC) are
available to train healthcare staff who assign ICD-10 and OPCS-4 (where systems allow)
codes to support episode data as part of the Admitted Patient Care (APC) dataset.

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As stated in the guidance associated with Data Security and Protection Toolkit Standard 3,
mental health coders can opt to attend the 21-day Clinical Coding Standards Course and 4-
day Clinical Coding Standards Refresher Course where organisations prefer this more in-
depth option.
The content and format of the current MHCCSC and MHCCSRC requires further review as a
consultation during 2019/20 conducted by the Terminology and Classifications Delivery
Service yielded very few responses.

5.1 Mental Health Clinical Coding Standards Course

As stated in the guidance associated with Data Security and Protection Toolkit Standard 3,
where clinical coding is performed by mental health clinicians, they can attend the three-day
Mental Health Standards Course in a series of six half-day sessions to support mandatory
data flows. Attendance on this course is important because, whilst clinicians are fully trained
and experienced in the clinical aspects of documenting a patient’s episode of care, they may
be unaware of some of the information that is needed for coding purposes, for example, the
importance of recording both primary and secondary diagnoses (and procedures where
systems allow) and the subsequent sequencing rules.
5.1.1 Pre-requisite skills, knowledge and experience
The Mental Health Clinical Coding Standards Course (MHCCSC) pre-requisite criteria
ensure that an applicant has the base skills and knowledge required to become a clinical
coder.
The MHCCSC is open to all staff already employed as a novice clinical coder, or a clinician
who assigns classification codes, in a Mental Health Trust.

It is essential therefore, that applicants fulfil all of the following criteria prior to attending the
MHCCSC:
1. Have been employed as a clinical coder for between one-six months. Ideally, the
novice clinical coder will have been working within the department for a minimum
of six weeks before attending the course

2. Have a personal commitment to continued professional development including

completion of assessment based learning in a variety of formats, e.g. classroom-
led learning, eLearning, self-learning and webinars

3. Have a structured training plan in place agreed with their line manager detailing
the time and resources available to complete all mandatory elements before,
during and after the course, as necessary

4. Have completed the following two mandatory eLearning courses prior to

attendance on the classroom MHCCSC

o Basic Anatomy and Physiology eLearning – all modules* (Provides certificate /

screen print from End of Course Assessment)
o Basic Introduction to Clinical Coding – Modules 1 and 2* (Provides certificate /
screen print from End of Module Tests).
*excludes clinicians

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5. Have all the necessary up-to-date classification books, reference books/manuals,

Chemotherapy Regimen and List and associated Clinical Coding Guidance
documentation to bring with them to the classroom course either in hard copy or
electronic formats.

IMPORTANT INFORMATION:
Criteria 4 – Will be evidenced by provision of certificates.
Criteria 5 – The MHCCSC course trainer will email a Clinical Coding Reference
Book/Manual Download Confirmation Form template to the line manager before the course
starts so that the manager can confirm that their coder(s) has copies of all the necessary
products for use during the classroom-based course either in hard copy or electronic
formats.
It is important that the applicant and line manager work together to ensure the
applicant meets all of the criteria listed above.
5.1.2 Booking a place on the Mental Health Clinical Coding Standards
Course (MHCCSC)
As per guidance associated with Data Security and Protection Toolkit Standard 3 , coding
managers must ensure that their novice clinical coder is booked on to a classroom-based
MHCCSC within six months of commencing employment within their department.
CCSC training can be arranged/booked through one of the following options:
1. An in-house Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer within your own department
2. A Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer based within a neighbouring / other Trust
3. A Commercial / Independent Terminology and Classifications Delivery Service
approved apprentice or experienced clinical coding trainer.
NB: A list of approved clinical coding trainers who have given their permission for us to
publish their details is available on Delen
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training programme costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the MHCCSC course details (Section 5.1.3) for further information about pre-course,
course and post-course requirements.
5.1.3 Mental Health Clinical Coding Standards Course Details
Course delegates and their line managers need to be aware of all the following content prior
to booking on to a course.

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5.1.3.1 Course Overview

This practical assessment-based course teaches recently appointed novice clinical coders
how to use their classification books and follow the four step coding process to ensure
correct application of ICD-10 and OPCS-4 national clinical coding standards and facilitate
accurate coded clinical data.
5.1.3.1.1 Mandatory pre-course eLearning
As referenced in Section 5.1.1, delegates must complete the following two mandatory
eLearning courses before attending the classroom element of the MHCCSC:
o Basic Anatomy and Physiology eLearning – all modules*
o Basic Introduction to Clinical Coding – Modules 1 and 2*
*excludes clinicians
These eLearning courses are hosted on the Digital Learning Solutions platform and are
accessible via the Classifications eLearning page on Delen.
Delegates must read the relevant guidance document prior to attempting to access the
eLearning hosted on the Digital Learning Solutions platform. This document clearly explains
the need to select “NHS Digital Terminology and Classifications Delivery Service” from
the list of options at the “Centre” field when prompted to “Select your centre / organisation” . If
they select their own organisation, they will not be able to access our materials.
There are 11 modules within the Basic Anatomy and Physiology eLearning package that the
novice coder must complete, including all the end of module and overall assessments.
Estimated time to complete this package is approximately four hours. A copy of the
delegate’s overall assessment results must be made available to the MHCCSC trainer prior
to attending the classroom course. The delegate and their line manager must therefore
factor in enough time before the classroom course for this to be done.
There are two modules within the ‘Basic Introduction to Clinical Coding’ eLearning package,
both of which require the delegate to complete a workbook requiring sign-off by their line
manager. Each workbook contains a number of activities. Some activities are to be done at
the delegate’s desk using the internet and other resources; some they need to find out
information from within their organisation. The workbooks must be complete and taken with
the delegate to the first day of their Mental Health Clinical Coding Standards Course; their
trainer will ask to see these. A copy of the delegate’s test results from each module must be
made available to the MHCCSC trainer prior to attending the classroom course. The
delegate and their line manager must therefore factor in enough time before the
classroom course for this to be done.
5.1.3.1.2 Benefits to the delegate
• Provides an optimal learning environment
• Gives access to highly experienced and skilled Terminology and Classifications Delivery
Service Approved Clinical Coding Trainers
• Provides understanding of the correct application of the national clinical coding training
standards for both ICD-10 and OPCS-4
• Develops delegate confidence to accurately code when back in the workplace, through
practical activities and assessments throughout the course
• Gives a greater understanding of the role and importance of clinical coding within the
delegate’s working environment

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• Supports an ongoing record of continued professional development through regular ongoing

training
• Can provide an opportunity to network with clinical coders from other organisations.

5.1.3.1.3 Benefits to the organisation

• Set of rigorous objectives that delegates are assessed against to support
competence and confidence when back in the workplace
• Classroom delivery by a learner-focused approved clinical coding trainer who can
deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all novice clinical coders
• Delivery by a skilled approved clinical coding trainer who understands the need for
accurate, high quality coded clinical data to support healthcare planning,
reimbursement, management of services, statistical analysis and research
• Increased effectiveness of formal training events and of learning transferred to the
workplace through ongoing online evaluation

• The opportunity to deliver a more cost-efficient in-house clinical coding training

programme to satisfy internal data quality, Data Security and Protection Toolkit
Standard 3 and other NHS regulatory body requirements.

5.1.3.1.4 Attendance criteria

This course is only available to clinical coders employed within a Mental Health Trust.

By the end of the Mental Health Clinical Coding Standards Course delegates will be able to:
• Correctly answer at least 80% of the questions on the Post Course Assessment using
the ICD-10 and OPCS-4 classifications.

5.1.3.1.5 What will the course cover?

Using classification books and reference products
• Learning about the organisation and structure of ICD-10 Volumes 1, 2 and 3
• Learning the basics about the organisation and structure of OPCS-4 Volumes I and II
• Using each step of the Four Step Coding Process to correctly assign ICD-10 codes
• Using each step of the Four Step Coding Process to correctly assign ICD-10 and
OPCS-4 codes in relation to electroconvulsive therapy (ECT) and rehabilitation
interventions only
• Navigating the National Clinical Coding Standards ICD-10 5th Edition and OPCS-4
reference books to locate national clinical coding standards
• Using the Coding Clinic

Applying national clinical coding standards

• Completing quick-fire scenarios and more detailed case studies to correctly assign
ICD-10 and OPCS-4 codes to dedicated Mental Health scenarios
• Completing recap exercises and other activities to reinforce the practical and
theoretical aspects of national clinical coding standards for ICD-10 and OPCS-4
• Using all available reference products to support accurate code assignment.
Data extraction and research
• Selecting all relevant conditions, circumstances and interventions to be coded by
following basic data extraction guidance and reviewing sample source documentation.

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Monitoring and assessment

• Completing regular practical and theoretical assessments to monitor personal
progress
• Identifying areas for further development where necessary.
Time management
• Completing individual exercises, assessments, and group activities to required
deadlines.

Ongoing requirements
• Mandatory Mental Health Clinical Coding Standards Refresher Course/Clinical Coding
Standards Referesher Course training
• Working towards accredited clinical coder (ACC) status.

5.1.3.1.6 Course Materials

Each delegate receives:
• Delegate course folder
• Written Exercises and Answer sheets
• Reference Handouts
• Individual Course Record of Assessment / performance report
• Certificate of Successful Completion.

5.1.3.1.7 Reference Materials

Important information
The delegate’s line manager must supply their delegate with a copy of the following in either
hard copy or electronic format for use during the course:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)*
• OPCS-4.9 Volumes I and II* NB: These are not essential as the necessary pages will
be provided as part of the course materials
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)**
• National Clinical Coding Standards OPCS-4 reference book (2021)**
NB: All classification books highlighted with an * should preferably be new and not passed
down from previous users as this can cause confusion for novice coders. ICD-10 5th Edition
books can be purchased from The Stationery Office via
https://www.tsoshop.co.uk/bookstore.asp?FO=1160643&DI=643306
To order OPCS-4.9 books (should you choose to do so), follow the link on Delen at
https://hscic.kahootz.com/gf2.ti/f/762498/58563845.1/PDF/-
/OPCS_4.9_Vol_I_and_II_NHS_digital_2020.pdf
NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an **. These can be found within the ICD-10, OPCS-4 and Other
sections on the Publications & Resources area on Delen.
Delegates may also use the OPCS-4.9 e-Version and ICD-10 5th Edition e-Version*. These
products can be downloaded via Delen. The online Classifications Browser is also available.
Coding Clinic Ref 88: Coding of Co-morbidities
NB: Delegates can download the latest version of the Coding Clinic onto their laptops/tablets
if desired from Delen.

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5.1.3.1.8 Course Timings

The course timings are:
Day 1: 09.30 – 16.30
Day 2: 09.00 – 16.30
Day 3: 09.00 – 15.15
5.1.3.1.9 Delegate Responsibilities – Summary
The delegate is responsible for:
• Ensuring punctuality at all time
• Respecting the course trainer and fellow delegates
• Completing and evidencing all mandatory pre-course eLearning prior to the classroom
training
• Completing all assessments to the required criteria.

5.1.3.1.10 Line Manager Responsibilities – Summary

The line manager is responsible for:
• Ensuring their novice coder attends a MHCCSC within six months of employment
• Providing clean copies of all reference products described in Section 2.3.1.8 above
• Providing ongoing support to the delegate to ensure sufficient time and resources are
available for completion of the two mandatory eLearning packages before the
classroom course.
5.1.3.1.11 Next Steps
Successful completion will result in compliance with Data Security and Protection Toolkit
Standard 3.

5.2 Mental Health Clinical Coding Standards Refresher

Course
5.2.1 Pre-requisite skills, knowledge and experience
The Mental Health Clinical Coding Standards Refresher Course pre-requisite criteria ensure
that an applicant has the ongoing skills and knowledge required by a clinical coder.
The MHCCSRC is open to all staff already employed as a clinical coder in a Mental Health
Trust.

Mental Health clinical coders must attend a Mental Health Clinical Coding Standards
Refresher Course (or if they choose a Clinical Coding Standards Refresher Course) once
every 3 years from their successful completion of a Mental Health Clinical Coding Standards
Course.

It is essential therefore, that applicants fulfil all of the following criteria prior to attending the
MHCCSRC:

1. Have been employed as a clinical coder for 2-3 years before attending their first
MHCCSRC

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2. Have attended a MHCCSRC (or CCSRC) three years ago (where applicable)
(Provides previous course certificate)
3. Have a personal commitment to continued professional development including
completion of assessment based learning in a variety of formats, e.g. classroom-led
learning, eLearning, self-learning, webinars

4. Have a structured training plan in place agreed with their line manager detailing the
time and resources available to complete all mandatory elements before, during and
after the course, as necessary

5. Have completed the following mandatory eLearning course prior to attendance on the
classroom MHCCSRC:

o Four Step Coding Process ICD-10 eLearning – all modules (Provides line
manager email confirmation / screen print / certificate from End of Course
Assessment)

6. Have all the necessary up-to-date classification books, reference books/manuals,

Chemotherapy Regimens List and associated Clinical Coding Guidance
documentation to bring with them to the classroom course either in hard copy or
electronic formats

IMPORTANT INFORMATION:
Criteria 2 and 5 – Will be evidenced by provision of confirmation email / screen print /
certificate.
Criteria 6 – Will be evidenced by line manager completion of the Clinical Coding Reference
Book/Manual Download Confirmation Form template to the course trainer before the course
starts so that the manager can confirm that their coder(s) has copies of all the necessary
products for use during the classroom-based course either in hard copy or electronic
formats.
It is important that the applicant and line manager work together to ensure the
applicant meets all of the criteria listed above.

5.2.2 Booking a place on the Mental Health Clinical Coding Standards

Refresher Course (MHCCSRC)
As stated in the guidance associated with Data Security and Protection Toolkit Standard 3,
the one day Mental Health Clinical Coding Standards Refresher Course (or Clinical Coding
Standards Refresher Course should it be preferred) must be attended every three years by a
Mental Health Trust coder.

MHCCSRC training can be arranged/booked through one of the following options:

1. An in-house Terminology and Classifications Delivery Service approved experienced
clinical coding trainer within your own department
2. A Terminology and Classifications Delivery Service approved experienced clinical
coding trainer based within a neighbouring / other Trust
3. A commercial / independent Terminology and Classifications Delivery Service
approved experienced clinical coding trainer.

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NB: A list of approved clinical coding trainers who have given their permission for us to
publish their details is available on Delen
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training programme costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the MHCCSRC course details (Section 5.2.3) for further information about pre-
course, course and post-course requirements.
5.2.3 Mental Health Clinical Coding Standards Refresher Course Details
Course delegates and their line managers need to be aware of all the following content prior
to booking on to a course.
5.2.3.1 Course Overview
This practical assessment-based course is fundamental to the continued professional
development of all experienced clinical coders by assessing that they are keeping their
practical coding skills and theoretical knowledge up-to-date for the ICD-10 and OPCS-4
(where applicable) clinical classifications and associated updates. The course also provides
experienced clinical coders with the opportunity to reinforce the four step coding process to
ensure correct application of ICD-10 and OPCS-4 national clinical coding standards to
facilitate accurate coded clinical data.
This course is delivered across one day in a classroom environment.
5.2.3.1.1 Mandatory pre-course eLearning and questionnaire
As referenced in Section 5.2.1, delegates must complete the following mandatory eLearning
course hosted on the Digital Learning Solutions platform and accessible via Delen before
attending the classroom element of the CCSRC:
o Four Step Coding Process ICD-10 eLearning – all 7 modules
Estimated time to complete this package is approximately 1.5 hours. The delegate and their
line manager must therefore factor in enough time before the classroom course for
this to be done.
Delegates must read the relevant guidance document prior to attempting to access the
eLearning hosted on the Digital Learning Solutions platform. This document clearly explains
the need to select “NHS Digital Terminology and Classifications Delivery Service” from
the list of options at the “Centre” field when prompted to “Select your centre / organisation” . If
they select their own organisation, they will not be able to access our materials.
5.2.3.1.2 Benefits to the delegate
• Provides an optimal learning environment
• Gives access to highly experienced and skilled Terminology and Classifications Delivery
Service Approved Clinical Coding Trainers

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• Provides reinforcement of the correct application of the

national clinical coding training standards for both ICD-
10 and OPCS-4
“Excellent refresher
• Opportunity to refresh and consolidate existing practical course to enable
coding skills for ICD-10 and OPCS-4 knowledge .”
• Opportunity to refresh and consolidate existing
theoretical coding knowledge for ICD-10 and OPCS-4
• Opportunity to apply this knowledge to consistently and
accurately identify the correct ICD-10 and OPCS-4
codes for a range of typical case note and more
complex mental health scenarios
• Opportunity to share clinical coding experiences and
best practice with fellow delegates
• Supports an ongoing record of continued professional development through regular ongoing
training
• Can provide an opportunity to network with clinical coders from other organisations.

5.2.3.1.3 Benefits to the organisation

• Set of rigorous objectives that delegates are assessed against to support
competence and confidence when back in the workplace
• Classroom delivery by a learner-focused approved clinical coding trainer who can
deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all novice clinical coders
• Delivery by a skilled approved clinical coding trainer who understands the need for
accurate, high quality coded clinical data to support healthcare planning,
reimbursement, management of services, statistical analysis and research
• Increased effectiveness of formal training events and of learning transferred to the
workplace through ongoing online evaluation

• The opportunity to deliver a more cost-efficient in-house clinical coding training

programme to satisfy internal data quality, Data Security and Protection Toolkit
Standard 3 and other NHS regulatory body requirements.

5.2.3.1.4 Attendance criteria

This course is only available to clinical coders employed within a Mental Health Trust.

By the end of the Mental Health Clinical Coding Standards Refresher Course delegates will
be able to:
• Accurately assign ICD-10 5th Edition and OPCS-4 codes to the given case studies to
at least 90% accuracy using the Four Step Coding Process.

5.2.3.1.5 What will the course cover?

Reinforcement of the four step coding process
• Using each step of the Four Step Coding Process to correctly assign ICD-10 and
OPCS-4 codes (where applicable).
Applying national clinical coding standards

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• Completing quick-fire mental health scenarios and more detailed case studies to
correctly assign ICD-10 and OPCS-4 codes (where applicable)
• Completing other individual and group activities to reinforce the practical and
theoretical aspects of national clinical coding standards for ICD-10 and OPCS-4
• Using all available reference products to support accurate code assignment.
Maintaining data extraction skills
• Selecting all relevant conditions, circumstances and interventions to be coded in
realistic case studies by following general coding standards.
Monitoring and assessment
• Completing practical and theoretical end of course assessment to monitor personal
progress
• Identifying areas for further development where necessary.
Time management
• Completing individual exercises and assessments and group activities to required
deadlines.
Ongoing requirements
• Mandatory three-yearly Mental Health Clinical Coding Standards Refresher Course
training
• Specialty workshops
• Accredited clinical coder status (where still required).

5.2.3.1.6 Course Materials

Each delegate receives:
• Delegate course folder
• Participant’s Workbook and Answer Book
• Individual Course Record of Assessment / performance report
• Certificate of Successful Completion.

5.2.3.1.7 Reference Materials

Important information
The delegate’s line manager must supply their delegate with a copy of the following in either
hard copy or electronic format for use during the course:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)*
• OPCS-4.9 Volumes I and II*
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)**
• National Clinical Coding Standards OPCS-4 reference book (2021)**
NB: All classification books highlighted with an * should preferably be new and not passed
down from previous users as this can cause confusion for novice coders. ICD-10 5th Edition
books can be purchased from The Stationery Office via
https://www.tsoshop.co.uk/bookstore.asp?FO=1160643&DI=643306
To order OPCS-4.9 books (should you choose to do so), follow the link on Delen at
https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=14270896#14270896

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NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an **. These can be found within the ICD-10, OPCS-4 and Other
sections on the Publications & Resources area on Delen.
Delegates may also use the OPCS-4.9 e-Version and ICD-10 5th Edition e-Version*. These
products can be downloaded via Delen. The online Classifications Browser is also available.
Coding Clinic Ref 88: Coding of Co-morbidities
NB: Delegates can download the latest version of the Coding Clinic onto their laptops/tablets
if desired from Delen.

5.2.3.1.8 Course Timings

The course timings are:
09.15 – 16.45
5.2.3.1.9 Delegate Responsibilities – Summary
The delegate is responsible for:
• Ensuring punctuality at all time
• Respecting the course trainer and fellow delegates
• Completing and evidencing all mandatory pre-course eLearning prior to the classroom
training
• Completing all assessments to the required criteria.

5.2.3.1.10 Line Manager Responsibilities – Summary

The line manager is responsible for:
• Ensuring their clinical coder completes a MHCCSRC every 3 years
• Ensuring availability of all reference products described in Section 5.2.3.1.7 above
• Providing ongoing support to the delegate to ensure sufficient time and resources are
available for completion of the mandatory eLearning package before the classroom
course.
5.2.3.1.11 Next Steps
Successful completion will result in compliance with Data Security and Protection Toolkit
Standard 3.

6 Introduction to Classifications training

6.1 Pre-requisite skills, knowledge and experience
There are currently no set pre-requisite criteria for attending Introduction to Classifications
training other than a recommendation that where possible, the attendee has completed the
Basic Introduction to Clinical Coding eLearning (Modules 1 and 2) if they are training to
become a clinical coder.
All four parts of the Introduction to Clinical Coding training are also open to any healthcare
professional interested in, or using, coded clinical data.

6.2 Booking a place on the Introduction to Classifications

(ITC) Training
Following delivery of the ITC training to all approved clinical coding trainers during 2020/21,
we are currently making changes to the materials and objectives based on trainer feedback

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and we hope to release the materials by end of June / early July 2021 to all approved clinical
coding trainers who met the course criteria.
This classroom designed training is not yet mandatory. It can also be delivered online by
those trainers who have our permission to deliver national training materials online, and we
will continue to take feedback so that we can look to reformat materials over the next couple
of years with the intention that this training will form part of the future national core
curriculum for clinical coders. Discussions will also be sought with IHRIM to determine if any
of the content would be suitable for the NCCQ (UK) in the future and the Institute for
Apprenticeships.
Introduction to Classifications training can be arranged/booked through one of the following
options:
1. An in-house Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer within your own department
2. A Terminology and Classifications Delivery Service approved apprentice or
experienced clinical coding trainer based within a neighbouring / other Trust
3. A commercial / independent Terminology and Classifications Delivery Service
approved apprentice or experienced clinical coding trainer.
NB: A register of approved clinical coding trainers who have given their permission for us to
publish their details is available on Delen
Confirmation of a trainer’s ‘approved’ status for those trainers whose names do not appear
on the list can be obtained by emailing [email protected]. During 2021/22 we
also have a list of those approved clinical coding trainers who have our permission to deliver
national training remotely. Details can be provided by emailing
[email protected].
Please note that since 1 April 2021, NHS Digital approved trainers are also allowed to use
an approved trainer ‘accreditation mark’ alongside their name, so please look out for this
when organising training through third parties.
Training programme costs will vary depending on the chosen option and fees are available
directly from the training provider, and not the Terminology and Classifications Delivery
Service.
Refer to the ITC course details (Section 6.3) for further information about pre-course, course
and post-course requirements.

6.3 Introduction to Classifications Training Details

ITC delegates and their line managers need to be aware of all the following content prior to
booking on to this training.
6.3.1 Training Overview
The ITC content, including the Workbooks, has been developed not only to bring back some
of the fundamentals that used to be in the old Clinical Coding Foundation Course but to
include additional content deemed relevant to ensure that people either coming in to coding
or working within coding have a good understanding of why we classify and the importance
of the role which will in itself not only better prepare and support them but should also
reinforce how vital their role and the data they produce is in supporting the many uses and
users of the coded clinical data.

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6.3.1.1 Optional pre-course eLearning

As referenced in Section 6.1, delegates can choose to complete the Basic Introduction to
Clinical Coding – Modules 1 and 2 hosted on the Digital Learning Solutions platform and
accessible via the Classifications eLearning page on Delen, although this eLearning is a
mandatory pre-requisite if the attendee is training to become a clinical coder and is due to
undertake CCSC training.
Delegates must read the relevant guidance document prior to attempting to access the
eLearning hosted on the Digital Learning Solutions platform. This document clearly explains
the need to select “NHS Digital Terminology and Classifications Delivery Service” from
the list of options at the “Centre” field when prompted to “Select your centre / organisation” . If
they select their own organisation, they will not be able to access our materials.
There are two modules within the ‘Basic Introduction to Clinical Coding’ eLearning package,
both of which require the delegate to complete a Workbook requiring sign-off by their line
manager. Each Workbook contains a number of activities. Some activities are to be done at
the delegate’s desk using the internet and other resources; some they need to find out
information from within their organisation. The Workbooks must be complete and taken with
the delegate to the first day of their Clinical Coding Standards Course; their trainer will ask to
see these. A copy of the delegate’s test results from each module must be made available to
the CCSC trainer prior to attending the classroom course. The delegate and their line
manager must therefore factor in enough time before the classroom course for this to
be done.
6.3.1.2 Training parts
This training teaches clinical coders of all levels of experience about the background to how
classifications developed, their purpose, their use both nationally and internationally, and
how they promote consistent code assignment to facilitate accurate coded clinical data.
This training is delivered across four parts, each part lasting 1.5-2 hours in length. The exact
course length must be agreed in advance between the approved clinical coding trainer and
the delegate’s line manager depending on the needs of the delegate / organisation.
The four parts cover:
Part One: Where do classifications come from and what are they for?
Group discussion
True / False Recap Exercise
Part One Workbook Exercises*
Part Two: The Family of Clinical Classifications – An introduction to some of the different
classifications
Part Two Workbook Exercises*
Part Three: Structure and Conventions – How classifications promote consistent code
assignment and facilitate different uses and users
Multiple Choice Recap Exercise
Part Three Workbook Exercises*
Part Four: Coded Clinical Data – Uses and Users of Classifications
Group Work
Part Four Workbook Exercises*

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The content of these Parts can currently be delivered in any order and at any point in a
clinical coder’s training as considered appropriate by the attendee’s line manager and/or
approved clinical coding trainer. The timing of the sessions is open for discussion between
the course trainer and the coding manager, e.g. Parts One and Two are probably more
suitable after the Basic Introduction to Clinical Coding eLearning and before the classroom
CCSC. Part Three is probably more relevant six months after the CCSC as a post-
consolidation module or to be delivered to experienced clinical coders as a refresher
session. Part Four is probably best delivered a year after CCSC training once attendees
have more day-to-day clinical coding experience. It is also suitable for experienced clinical
coders, including approved clinical coding auditors, as well as other healthcare professionals
such as clinicians and data analysts.
*The Workbooks each contain several reinforcement exercises including an element of
research and can be completed at a pace that suits the individual either during work time or
their own time, depending on organisational requirements. NB: Each workbook takes
approximately 2-3 hours to complete and must meet the required criteria to allow for
the relevant Introduction to Classifications certificate to be issued for each part
attended.

6.3.1.3 Benefits to the delegate

• Provides an optimal learning environment
• Gives access to highly experienced and skilled NHS Digital approved clinical coding
trainers
• Provides a more in-depth understanding of the purpose of classifications and their
structure
• Develops delegate confidence to use classifications correctly and to explain their
purpose to others
• Gives a greater understanding of the role and importance of clinical coding within the
delegate’s working environment
• Supports an ongoing record of continued professional development through regular
ongoing training
• Can provide an opportunity to network with clinical coders from other organisations.

2.3.1.4 Benefits to the organisation

• Elements of self-learning to instil or refresh research skills in the clinical coder
• Set of rigorous objectives that delegates are assessed against to support
competence and confidence when back in the workplace
• Classroom delivery by a learner-focused approved clinical coding trainer who can
deliver formal clinical coding training that complies with the Clinical Coding Trainer
Framework and is engaging to all clinical coders and other healthcare professionals,
where appropriate
• Delivery by a skilled approved clinical coding trainer who understands the need for
accurate, high quality coded clinical data to support healthcare planning,
reimbursement, management of services, statistical analysis and research
• Increased effectiveness of formal training events and of learning transferred to the
workplace through ongoing online evaluation

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• The opportunity to deliver a more cost-efficient in-house clinical coding training

programme to satisfy internal data quality requirements.

6.3.1.5 Attendance criteria

This training is available to all clinical coders, regardless of level of experience, employed
within an NHS Trust (including a Mental Health Trust, or an independent sector treatment
centre (ISTC) which treats, and codes consultant episodes for, NHS patients). It is also
available to other healthcare professionals such as clinicians and data analysts and other
users of coded clinical data.

Delegates and line managers need to be aware in advance of what the training involves so
that they understand the time and effort required to meet the objectives*. Delegates are
required to:

• Complete a number of exercises in the classroom and in their Workbooks throughout

the training and in-between parts
• Successfully complete all exercises within each workbook
• Successfully complete any Development Plan Agreements within agreed timescales
where an individual does not meet any of the Part objectives.

*ITC objectives are currently still being finalised.

Where Development Plan Agreements are required, the trainer, the delegate and the
delegate’s line manager must agree on the appropriate course of action, timeframes, how
the Development Plan will be checked and by whom.

The delegate will only receive a Certificate of Successful Completion when they fully
evidence they have met all the ITC objectives for the parts they attend. Certificates will
therefore only be issued on successful completion of Development Plans where these are
required.

6.3.1.6 Training Materials

Each delegate receives:
• Written Exercises and Answer sheets
• Reference and Slide Handouts
• Workbooks
• Certificate of Successful Completion.

6.3.1.7 Reference Materials

Important information
The delegate’s line manager must supply their delegate with a copy of the following in either
hard copy or electronic format for use during the course:
• Volumes 1 and 3 of ICD-10 5th Edition (fully updated to reflect the errata published in
the Coding Clinic Ref 115)*
• OPCS-4.9 Volumes I and II*
• National Clinical Coding Standards ICD-10 5th Edition reference book (2021)**
• National Clinical Coding Standards OPCS-4 reference book (2021)**

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NB: All classification books highlighted with an * should preferably be new and not passed
down from previous users as this can cause confusion for novice coders. ICD-10 5th Edition
books can be purchased from The Stationery Office via
https://www.tsoshop.co.uk/bookstore.asp?FO=1160643&DI=643306
To order OPCS-4.9 books, follow the link on Delen at
https://hscic.kahootz.com/gf2.ti/f/762498/58563845.1/PDF/-
/OPCS_4.9_Vol_I_and_II_NHS_digital_2020.pdf
NB: Delegates are welcome to bring laptops/tablets to access electronic versions of the
products highlighted with an **. These can be found within the ICD-10, OPCS-4 and Other
sections on the Popular Publications area on Delen.
Delegates may also use the OPCS-4.9 e-Version and ICD-10 5th Edition e-Version*. These
products can be downloaded via Delen. The online Classifications Browser is also available
6.3.1.8 Training Timings
The training timings will be provided by the course trainer.

6.3.1.9 Delegate Responsibilities – Summary

The delegate is responsible for:
• Ensuring punctuality at all times
• Respecting the course trainer and fellow delegates
• Attending all agreed parts of the ITC training
• Completing all Workbook exercises to the timeframes instructed by the course trainer
• Completing all necessary Development Plans to the required criteria and timeframes
supplied by the course trainer.

6.3.1.10 Line Manager Responsibilities – Summary

The line manager is responsible for:
• Providing clean copies of all reference products described in Section 6.3.1.7 above
• Providing ongoing support to the delegate to ensure sufficient time and resources are
available for completion of the agreed parts of the training including time to complete
Workbook exercises
• Discussing with the course trainer appropriate Development Plan Agreements and
timeframes during the course and/or after the course where necessary, and providing
ongoing support for the delegate to complete these.

7 Other Useful Information

The information below provides links to other optional courses and eLearning available to
coders as part of their ongoing continued professional development.

7.1 Clinical Coder Apprenticeship

The Institute for Apprenticeships officially approved the Clinical Coder Apprenticeship
Standard in April 2019. To find out more about this Standard and the NHS Trusts involved in
its creation visit https://www.instituteforapprenticeships.org/apprenticeship-standards/clinical-
coder/

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7.2 Health Informatics

The following documents provide information about careers within Health Informatics:

https://www.healthcareers.nhs.uk/sites/default/files/documents/Careers%20in%20health%20
informatics.pdf
https://www.hee.nhs.uk/sites/default/files/documents/Health%20Informatics%20Career%20P
athways%20Report%20A%20v1.pdfInformed: An introduction to the use of informatics in
healthcare
This is an e-learning course developed by the Department of Health. The course is available
for NHS employees who want to expand their knowledge of health informatics: http://www.e-
lfh.org.uk/programmes/health-informatics/

7.3 SNOMED CT Foundation Course

This is an eLearning course developed by SNOMED International. The course is available
to anyone seeking to acquire or demonstrate a broad foundational knowledge of SNOMED
CT.

Study itself is expected to require a total of 30-35 hours. The course must be completed
within a maximum of four months, but it is possible to complete it within as little as a week.
Registration is required.

Foundation (ihtsdotools.org)

7.4 SNOMED CT Awareness for Clinical Coders

This presentation provides a basic overview of:

• the differences between SNOMED CT and the ICD-10 and OPCS-4 classifications
• the content and structure of SNOMED CT
• the link between SNOMED CT and the classifications
• the purpose of the classifications maps
• the different types of classifications maps

Delen

7.5 NHS Data Model and Dictionary

The NHS Data Model and Dictionary gives a reference point for assured information
standards, to support health care activities in the NHS in England. The NHS Data Model and
Dictionary has been developed for everyone who is actively involved in the collection of data
and the management of information in the NHS.
The NHS Data Model and Dictionary Service provides the development, maintenance and
support of NHS Information Standards

About the NHS Data Model and Dictionary (datadictionary.nhs.uk)

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