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Title: Opcs-4  
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Subject: Procedure code, Medical classification, HCPCS Level 2, Topographical code, International Classification of Health Interventions
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OPCS-4, or more formally OPCS Classification of Interventions and Procedures version 4,[1] is the procedural classification used by clinical coders within National Health Service (NHS) hospitals of NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. It is based on the earlier Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (4th revision),[2] and retains the OPCS abbreviation from this now defunct publication.

OPCS-4 codifies operations, procedures and interventions performed during in-patient stays, day case surgery and some out-patient treatments in NHS hospitals. Though the code structure is different, as a code set, OPCS-4 is comparable to the American Medical Association's Current Procedural Terminology.

As a publication, OPCS-4 is split into two volumes; a tabular list (Volume I) and an alphabetical index (Volume II).[3] An electronic version is also available.[4] However, a number of supplementary publications are also used by coding staff.


The first NHS procedural classification was published in 1987, by the Office of Population Censuses and Surveys (OPCS) as the Classification of Surgical Operations. In 1992 the 4th revision was released as the OPCS Classification of Surgical Operations and Procedures (4th revision),[2] usually shorted to OPCS-4.2. Responsibility for the classifications used in the NHS, including OPCS-4, passed to the NHS Information Authority (NHS IA) when it formed in 1999.

By 2003, the NHS IA had realised OPCS-4.2 no longer accurately reflected many of the procedures being performed in the UK healthcare system. As a medium term measure, a project to replace OPCS-4 with a more robust method of procedure coding was proposed and partially developed. Rather than using a sequence of codes to capture activity, the new classification would have used a single alphanumeric code up to 15 characters long. When the NHS IA was superseded by NHS Connecting for Health (NHS CFH) in 2005, the project was placed on indefinite hold, and a program of annual revisions to OPCS-4 was implemented. Much of the development work for the suspended project was reused to produce the initial expansion and enhancement of OPCS-4.2 to OPCS-4.3. However, OPCS-4.2 remained the mandated method of procedural classification in the NHS setting until March 2006.[5]

Since the implementation of OPCS-4.3 in April 2006 there have been four further revisions to OPCS-4. Each becoming the mandated classification on 1 April in the year of publication.

OPCS-4 version mandated for use (financial year)[6]

  • Up to 31 March 2006 OPCS-4.2
  • 2006-7 OPCS-4.3
  • 2007-9 OPCS-4.4
  • 2009-11 OPCS-4.5
  • 2011-14 OPCS-4.6
  • 2014 OPCS-4.7 (until further notice)[5]

Whilst additions to OPCS-4 are reviewed on an annual basis, the long term plan is to replace OPCS-4 with SNOMED CT.[7]

On 31 March 2013 NHS CFH ceased to exist. Since 1 April 2013, responsibility for revision and maintenance of OPCS-4 has been with the Health and Social Care Information Centre's Clinical Classifications Service.[8]

Code structure

OPCS-4 is an alphanumeric nomenclature, with a 4 character code system similar to that found in ICD-10. The differences being that OPCS-4 classifies procedures and interventions, rather than diagnoses, and that the chapters do not correlate (i.e. Chapter A of OPCS does not classify treatments for conditions in Chapter I of ICD-10).

The first character is always a letter. Second, third and fourth characters are always numbers. A . separates the third and fourth characters; for example
Syntax of an OPCS-4 code
1st character 2nd character 3rd character 4th character
A 0 1 .1

Volume I - Tabular List

OPCS-4 Volume I is split into 24 chapters:

  • Chapter A - Nervous System
  • Chapter B - Endocrine System and Breast
  • Chapter C - Eye
  • Chapter D - Ear
  • Chapter E - Respiratory Tract
  • Chapter F - Mouth
  • Chapter G - Upper Digestive System
  • Chapter H - Lower Digestive System
  • Chapter J - Other Abdominal Organs, Principally Digestive
  • Chapter K - Heart
  • Chapter L - Arteries and Veins
  • Chapter M - Urinary
  • Chapter N - Male Genital Organs
  • Chapter P - Lower Female Genital Tract
  • Chapter Q - Upper Female Genital Tract
  • Chapter R - Female Genital Tract Associated with Pregnancy, Childbirth and the Puerperium
  • Chapter S - Skin
  • Chapter T - Soft Tissue
  • Chapter U - Diagnostic Imaging, Testing and Rehabilitation
  • Chapter V - Bones and Joints of Skull and Spine
  • Chapter W - Other Bones and Joints
  • Chapter X - Miscellaneous Operations
  • Chapter Y - Subsidiary Classification of Methods of Operation
  • Chapter Z - Subsidiary Classification of Sites of Operation

"Missing" chapters

I codes

There is currently no Chapter I. Nor are there any codes beginning with an "I".

O codes

Whilst there is no Chapter O, codes beginning with an "O" can be found in OPCS-4. These were added to chapters when all the available 3-character code blocks were exhausted, but further classifications were needed. They are also referred to as "overflow codes", and are located at the end of the related chapter. When indexing a procedure or intervention that is classified to an O code, the letter denoting the chapter the code is found in is given in parentheses after the code.

Volume II - Alphabetical Index

OPCS-4 Volume II is an index for looking up codes in Volume I. It is bad practice to use it by itself, as some trails only index to the 3rd character category, rather than the 4th character rubric.

It is split into four numbered sections and an introduction.


The introduction gives a brief guide on using OPCS-4 and defines some abreviations, for example NEC (Not Elsewhere Classified).

Section I – Alphabetical Index of Interventions and Procedures

This is the main bulk of the index, and contains the mechanism of looking up codes in the tabular list.

Terms are indexed in a What? Where? How? method. For example, oesophagogastroduodenoscopy is trailed via Examination Gastrointestinal Tract Upper Endoscopic Fibreoptic.[9]

Section II – Alphabetical Index of Surgical Eponyms

This list of surgical eponyms, contains common NHS procedures that may also be known by the surgeon, team or institution that developed the method or device used. For example the Birmingham hip resurfacing and the Thompson Hemiarthroplasty.

Care must be taken when using trailing via Section II for two reasons:

  1. The eponyms given are based on the original description, of the original procedure. If a modified version of the procedure has performed, for example a modified Akin osteotomy, or if the operation has been performed in conjuntion with another procedure, e.g. Akin and Scarf osteotomies, the W15.6[10] code given in the index may not be correct.
  2. Only a single term is used to index the eponyms, i.e. Birmingham rather than Birmingham hip resurfacing.[11] This means that care must be taken where the same eponym has been used more than once. For example, on indexing Thompson, you find four separate entries that apply to different procedures: Thompson's lymphoedema correction, cemented Thompson hemiarthroplasty, uncemented Thompson hemiarthroplasty, and Thompson's quadricepsplasty

Section III – Alphabetical Index of Surgical Abbreviations

This section of the Volume II contains a nonexhaustive, alphabetical list of abbreviations and their definitions. For example, ECMO - Extracorporeal Membrane Oxygenation.[12]

The reason the descriptor of the abbreviation is given is to clarify the few instances where the abbreviation has been used more than once. For example, SST could stand for Serum Skin Test or Short Synacthen Test.[13]

Section IV – Alphabetical Index of Common Surgical Suffixes

This section of Volume II is a single page glossary containing suffixes that are used throughout the classification. For example, -otomy.

Supplementary publications

There are a number of publications that supplement OPCS-4.

Instruction Manual

The OPCS-4.6 Clinical Coding Instruction Manual is a reference book on how to use OPCS-4 to national standards. It is initially supplied to novice coders who attend a foundation course run by an Approved Trainer. Whilst each revision to OPCS-4 sees the issue of a new manual, updates are issued electronically, and the onus is on coders to update them by hand.

With the introduction of OPCS-4.7, and the move of maintenance responsibility to HSCIC, the instruction manual has been renamed to National Clinical Coding Standards OPCS-4.

The Coding Clinic

The Coding Clinic publication is how minor changes and coding advice for both ICD-10 and OPCS-4 are disseminated through the UK clinical coding community. Initially issued as a printed newsletter, in 2012 the format was switched to a single, compendium-like electronic publication.

High Cost Drugs List

Maintained by the Department of Health's (DH) Payment by Results team; the High Cost Drugs List is a catalogue of drugs licensed for use in the NHS that are excluded from the Payment by Results (PbR) tariff.

Issued annually - even in years with no revision to OPCS-4 - the list consists of the generic names of certain drugs next to the relevant OPCS-4 code. The guidance section of the list states that it is down to the clinical staff to use the generic instead of brand names.

Chemotherapy Regimens List

The Chemotherapy Regimens List, also issued by the DH Payment by Results team, is for the coding of administration of Drug trials are excluded as they are usually financed by the trial's commissioner, for example a pharmaceutical company or cancer charity.

The National Clinical Coding Standards OPCS-4 and both of the DH lists are issued to coders via Terminology Reference Data Update Distribution Service (TRUD)[1]


As an NHS publication, OPCS-4 is covered by Crown Copyright.

Derived works

The Clinical Coding and Schedule Development (CCSD) Group's Schedule of Procedures is based upon OPCS-4.[14]

See also


  1. ^ TSO Shop . Retrieved 15 September 2014. 
  2. ^ a b "Background to OPCS-4 development"Health and Social Care Information Centre: . Retrieved 2014-03-14. 
  3. ^ "OPCS-4.7 - next version"Health and Social Care Information Centre: . Retrieved 2014-03-13. 
  4. ^ "OPCS-4 eVersion"Health and Social Care Information Centre: . Retrieved 2014-03-13. 
  5. ^ a b "OPCS-4 Classification"Health and Social Care Information Centre: . Retrieved 2014-03-13. 
  6. ^ "OPCS Classification of Interventions and Procedures"NHS Data Dictionary: . Retrieved 2012-05-01. 
  7. ^ "National intervention classifications"Department of Health – NHS Financial Reforms: . Retrieved 2011-11-05. 
  8. ^ "About the Clinical Classifications Service". HSCIC. Retrieved 14 September 2014. 
  9. ^ OPCS classification of interventions and procedures, version 4.7, Volume II - Alphabetical Index. London: TSO. 2014. p. 58.  
  10. ^ OPCS classification of interventions and procedures, version 4.7 volume II. London: TSO. 2014. p. 181.  
  11. ^ OPCS classification of interventions and procedures, version 4.7 volume II. London: TSO. 2014. p. 182.  
  12. ^ OPCS classification of interventions and procedures, version 4.7. London: TSO. 2014. p. 211.  
  13. ^ OPCS classification of interventions and procedures, version 4.7. London: TSO. 2014. p. 212.  
  14. ^ "Copyright in the CCSD Schedule, CCSD Schedule with Hospital Classifications, Bulletins and supportive documents". CCSD. Retrieved 19 September 2014. 

External links

  • Official site by HSCIC
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