Clinical coding for pharmacists in general practice

Clinical coding for pharmacists in general practice: the short version

Clinical coding for pharmacists in general practice means recording what you did in the patient's record using a structured clinical term, not free text alone. In EMIS Web and SystmOne that term comes from SNOMED CT, the single clinical terminology the NHS uses across primary care. Every structured medication review, medicines reconciliation, intervention and monitoring check should carry a code, because a coded entry is the version of your work the system can find, count and act on. Code it correctly and your review lands in the right register, the right search and the right PCN report. Leave it as a free-text consultation note and, for reporting purposes, it may as well not have happened.

What SNOMED CT actually is

SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) is the terminology mandated across NHS primary care clinical systems. It sits underneath the interface you type into, so when you pick "Medication review done" or "Structured medication review", the system stores a specific concept with a numeric ID behind the readable term. Medicines themselves are coded through dm+d, the NHS BSA Dictionary of medicines and devices, which maps onto SNOMED. You do not need to memorise any of the numbers. You search the words.

Coding matters because it is what everything downstream reads. Registers, safety searches, recall lists, decision-support prompts and the extracts that feed QOF and the Network Contract DES all run on codes, not on your prose. A beautifully written free-text entry is invisible to a search for "patients with no medication review in 12 months". A single correct code makes that patient appear or disappear from the list.

One warning worth taking seriously: SNOMED concept IDs are not stable reference points to copy between practices. Concepts get inactivated and replaced, and the exact picking list differs between EMIS and SystmOne. So the safe habit is always the same. Search the term in your own system, check it against your practice's agreed code set, and if in doubt ask your practice's coding lead or clinical system administrator. Do not paste a number from a forum into a live record.

Why your coding drives payment and workload data

Structured medication reviews are a requirement of the Network Contract DES. They must be delivered by an appropriately trained clinician working within their competence, who holds an independent prescribing qualification and has advanced clinical assessment and history-taking skills — in practice mainly clinical pharmacists, and also GPs and suitably qualified advanced nurse practitioners. Pharmacy technicians support this work (for example through medicines reconciliation) but do not conduct the SMR itself. The DES does not pay a fee per review. What it does is expect your PCN to identify priority patients and evidence that the reviews are being delivered, and that evidence is your coded activity. When commissioners or your ICB ask how many SMRs a network has completed, the answer is a search on the SMR code, not a count of your clinic letters.

The same coded entries feed QOF long-term condition reviews, local incentive schemes and the practice's own workload data. If you have ever felt that your work is under-counted, uncoded activity is usually the reason. Coding is also how patient safety work becomes measurable. A run of interventions on high-risk medicines only shows up as a pattern if each one was coded at the time.

How to code a structured medication review

SNOMED holds a specific concept for a structured medication review, and separate concepts for when the review was offered but the patient declined or did not attend. The practical points:

• Completed: code the SMR as done, on the date you did it. This is the SMR SNOMED code your PCN report is counting.
• Declined: use the declined concept. A patient who turns down a review is a valid, coded outcome, not a blank. Add a short note on what was offered.
• Not attended: code the DNA so the episode is closed cleanly and the patient can be re-invited rather than silently dropping off the list.

Because these codes vary by system, search "structured medication review" in EMIS or SystmOne and pick from your agreed code set.

Medication review is not the same as a structured medication review

This trips people up constantly. A "medication review" code satisfies the general (GMS) contractual expectation that repeat medication is reviewed periodically. A "structured medication review" is the specific, in-depth, shared decision-making consultation defined under the PCN DES for prioritised patients. They are different codes for different jobs. Coding an SMR only as a plain medication review under-sells the work and can leave your PCN unable to evidence the DES activity. If you are still building your SMR consultation itself, our guide on how to do a structured medication review walks through the clinical process before you reach the coding step.

Coding medicines reconciliation, interventions and high-risk monitoring

The SMR is only part of what you code in a week. The other everyday categories:

• Medicines reconciliation: there is a specific concept for reconciliation, distinct from a medication review. Code it after a discharge or clinic letter when you have confirmed what the patient is actually taking against what is on the record.
• Interventions: when you stop, start, switch or adjust a medicine, or resolve a discrepancy, code the intervention. This is how safety work becomes countable rather than invisible.
• High-risk monitoring: DMARDs such as methotrexate, plus lithium, amiodarone and similar drugs, need monitoring recorded against the right codes so recall searches work. Check the current BNF and your local shared-care protocol for the actual intervals, because those vary by agreement rather than being a single national number.

If deprescribing decisions in older patients are your focus, the STOPP/START v3 reference and drill pairs well with coding the interventions you make as a result.

What makes a review record "complete"

Take Mr Ali, 78, on 12 medicines, seen for an SMR after a hospital admission. A complete record goes well beyond the SMR code: the reconciliation against his discharge summary, each intervention coded (you stopped a duplicate PPI and flagged an interacting pair), the high-risk monitoring you arranged, the completed outcome, and a clear note of what you agreed with him and asked the GP to authorise. Your prescriber request belongs in a clean action letter; see how to write a medication review action letter to a GP for the format that gets actioned quickly.

A useful test before you save: could a colleague who has never met Mr Ali reconstruct what you found, what you changed and why, from the codes and the note alone? If not, it is not finished. This is the "good, missed or unsafe" standard, applied to your own record-keeping. You can rehearse the whole loop, including the coding, in the Coding Trainer and Medication Review labs on our Practice Labs, and the underlying competencies are mapped across the curriculum.

Clinical coding for pharmacy technicians

Clinical coding for a pharmacy technician is core work, not an add-on. Reconciliation after discharge, queries actioned, safety checks, synchronisation of repeats and monitoring recalls all belong in the coded record, within your competence and local governance. Technicians frequently do the reconciliation that a pharmacist's SMR then builds on, so accurate coding at the technician stage protects the whole downstream review. Log the learning in your private CPD log too. Coding decisions make good material for the CPD records and reflective account the GPhC expects at revalidation.

Frequently asked questions

What is the SNOMED code for a structured medication review?

SNOMED CT holds a specific concept for a structured medication review, plus separate concepts for declined and not attended. Because the numeric concept IDs vary between EMIS and SystmOne and change over time, search the term in your own system and use your practice's agreed code set.

How do I code an SMR that the patient declined?

Use the declined concept for a structured medication review rather than leaving the record blank. A declined review is a valid coded outcome that keeps the patient counted correctly and lets them be re-invited. Add a brief note recording what you offered.

Is a structured medication review the same as a medication review?

No. A medication review is the periodic check on repeat medicines that meets the general (GMS) contractual expectation. A structured medication review is the in-depth, shared decision-making consultation defined under the Network Contract DES for prioritised patients. They use different codes, and coding an SMR only as a plain medication review under-records the work.

Can pharmacy technicians add clinical codes in EMIS and SystmOne?

Yes. Pharmacy technicians code reconciliation, actioned queries, safety checks and monitoring recalls as part of their role, within their competence and local governance arrangements. Accurate coding at the technician stage supports the pharmacist-led review that follows.

If you want to practise coding an SMR, a reconciliation and an intervention on realistic records before you do it on a patient, the scored Practice Labs are the place to make the mistakes safely.