Additional Early Recall Codes For GOS

12 February 2025

Hi all

Please find below an email from NHS England outlining additional early recall codes for certain situations. Apologies for any issues with the layout.

Kind regards

Herts LOC

,
Dear colleague

I am writing to you to provide an update on an interim PCSE system change which will be introduced overnight on 28/29 November 2024.

As you will be aware, the minimum frequency intervals for sight tests were set out in a Memorandum of Understanding (MoU) between the Department of Health and Social Security (as it was known at the time) and the optometry profession in 2002.

Whilst this is not changing, we have become aware that for four of the clinical scenarios the current PCSE system does not contain the necessary business rules for processing these claims correctly. As a result, performers have been required to process claims for the following clinical scenarios using an early retest code:

• Ocular hypertension and not in a monitoring scheme – 1 year frequency

• Under 16 with binocular vision anomaly – 6 month frequency

• Under 7 years with corrected refractive error – 6 month frequency

• 7 years and over and under 16 with rapidly progressing myopia – 6 month frequency

Interim PCSE system change

A full system fix is planned during the 2025/26 financial year. However, to avoid contractors and performers needing to use an early retest code to proceed with

claims for these patients, a new set of clinical priority codes will enable contractors to accurately process claims in the meantime. These will be added at the end of the drop-down menu for early retest codes within PCSE Online. We expect that PMS providers will take varying approaches to implementing this change and you should

check with your service provider.

The additional clinical priority codes are as follows:

• 7.1 Under 7 years – corrected refractive error

• 7.2 Under 16 years – binocular vision anomaly

• 7.3 7-16 years – rapidly progressing myopia

• 7.4 Ocular hypertension and not in a monitoring scheme

These codes should be used when processing a claim for a patient who meets one if the above clinical circumstances and are seen at, or after, the minimum frequency interval.

If there is a clinical justification for these patients to have a sight test sooner than the minimum frequency, performers should add an early retest code as per standard procedures, rather than the clinical priority code.

Please note that the introduction of the new clinical priority codes does not alter the MoU, which remains unchanged.

Long term solution

NHS England is currently working with PCSE to scope a long-term solution that enables the clinical circumstances to be recorded and processed correctly. It is envisaged that this will be introduced to the PCSE system in 2025/26.

Thank you for your continued commitment to delivering NHS funded eye care. If you have any queries, please contact us on hweicbhv.optical@nhs.net Please accept our apologies for the short notice notification.

Kind regards

Nik Thoren

Senior Policy Manager

Dentistry and Optometry Contracting and System Oversight

Primary Care and Community Services

Chief Operating Officer (COO) Directorate

NHS England

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