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The OPCS Classification of Interventions and Procedures Version 4.5 is to be used in the NHS from 1 April 2009. The Classification is an NHS Fundamental Information Standard developed and maintained by NHS Connecting for Health and used by health care providers and Strategic Health Authorities throughout the NHS. The OPCS-4 Classification system is now reviewed annually. This latest version continues the enhancement of the OPCS-4 Classification to reflect changes in clinical practice. The Classification supports various forms of data collection, such as Central Returns and Commissioning Data Sets, as well as other secondary uses of information essential to planning and improving patient care. The enhancements in OPCS-4.5 continue to reflect changes to clinical care in recent years and enables clinicians, in collaboration with clinical coders, to better describe interventions and procedures. The ability to provide improved clinical information continues to ensure the classification meets the needs of the Government's reform of NHS funding - Payment by Results (PbR). The Alphabetical Index (Volume II) is integral to the use of the classification when used in conjunction with the Tabular List (Volume I), which must be used as the primary coding tool.