National Clinical Coding Qualification (UK)

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The National Clinical Coding Qualification (UK) is the only nationally recognised qualification for clinical coders working in the NHS. Upon passing the examination a clinical coder is able to use the post-nominal letters ACC.

A novice NHS clinical coder needs to agree a 2-3 year development plan with their employer to complete the necessary training, acquire the skills, knowledge and practical work experience to become competent in clinical coding and be ready to sit the examinations to achieve accreditation. The breadth of coding skills and knowledge which is covered by the National Clinical Coding Examination are derived from the framework of the national clinical coder curriculum.



The qualification was established by NHS Connecting for Health in partnership with administration and awarding body, the Institute for Health Record and Information Management (IHRIM). It was also developed in collaboration with the NHS Scotland, NHS Cymru, and the Health and Social Services Executive (Northern Ireland).


The National Clinical Coding Qualification (UK) supports the need for good quality clinical information, as outlined in the Information for Health and the NHS Plan. One of the driving purposes of creating the NCCQ (UK) was to create a structured career path within Clinical Coding in the UK.

The NCCQ has become more popular in recent years. Agenda for Change (AfC) arrangements, contractual obligations and Continuing Professional Development (CPD)[2] are seen as the driving forces.

Certainly since AfC's inception in 2004 it is not uncommon for a Clinical Coder's contract to include a requirement to take the NCCQ within a set time frame from the Coder's starting date (NHS Digital and IHRIM recommend a development plan of two-three years to acquire the theoretical and practical skills to be ready to sit the examinations. In many trusts passing the NCCQ is an instant promotion under AfC. However, the actual 'banding' can vary from region to region and indeed trust to trust. Having the NCCQ is quickly becoming a prerequisite of team leader and coding manager positions throughout the UK. Clinical Coders who wish to become approved auditors or trainers must have attained the NCCQ.



The NCCQ exam is taken over the course of one day.

In the morning there is a three hour practical paper which is split into three sections.

• A1 Quick fire ICD-10 questions (15% of the marks)
• A2 Quick fire OPCS-4 questions (15% of the marks)
• B Case Study (70% of the marks)

There are 15 questions in sections A1 and A2 and seven case study questions in Section B. The first case study requires Index trails from the Alphabetical Index (Volume 3)

In the practical paper the coder is allowed their tabular and index copies of ICD-10 and OPCS 4 (annotated with coding clinics) and a copy of BNF. Medical dictionaries are not allowed.

The pass mark is 90%, with a distinction given for achieving a pass mark of 95% or more.

In the afternoon the three hour theory paper test the coder’s knowledge of the theory of ICD10, OPCS-4, Snomed CT, medical terminology and anatomy and physiology. Coders are not allowed to take any additional materials into this exam.

The pass mark is 60%, with a distinction given for those achieving a pass mark of 80% or more.


Resits are possible. The coder is able to retake individual papers but must pass within the next 3 examinations or they will have to retake both papers again


There are 2 laptops available to ensure IHRIM's examinations are accessible. Allocation will be subject to meeting certain health criteria and will be allocated on a first come first served basis.

Changes to operational arrangements

NHS Digital – Clinical Classifications Service and the Institute of Health Records and Information Management (IHRIM) have agreed operational changes to support the delivery of the National Clinical Coding Examinations.

The Clinical Classifications Service and IHRIM partnership is a voluntary arrangement and the design, development and delivery of the assessment has been a natural evolution over a number of years.

Following a review of organisational roles and responsibilities, it was agreed the development of the assessment would be transferred to IHRIM from 1 April 2014.

Transitional arrangements were implemented to ensure a smooth handover and knowledge transfer during the first year of change. IHRIM is committed to supporting the assessment and ensuring it continues to be delivered effectively and efficiently. The September 2014 examination was the first one delivered under this new arrangement.

The Clinical Classifications Service undertakes assurance of standards in line with the NHS Digital current syllabus, programme of study, national classification and clinical coding standards.

Oversight of the National Clinical Coding Qualification will be undertaken through the Partnership to ensure it is a robust and rigorous assessment of clinical coders’ knowledge and skills to demonstrate a minimum level of clinical coding competency.

A Memorandum of Understanding will be signed by both organisations going forward, to reflect the partnership arrangements. Both organisations remain committed to the recognition of competent clinical coders, part of the health informatics discipline within health and social care.


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