Coding Rule is effective for event records with an event end date on or after 1 April 2016
Ref No: Q2998 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: External cause code for allergic reaction to over the counter hair dye
Q:
What is the correct external cause code to assign for an allergic reaction to personal use of over the counter hair dye?
A:
The Table of Drugs and Chemicals (ICD-10-AM Alphabetic Index) has the following index entries:
Hair
- dye ...... T49.4 X44 X64 Y14 Y56.4
- preparation NEC...... T49.4 X44 X64 Y14 Y56.4
The appropriate external cause code for the scenario cited is X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances.
The code for adverse effect in therapeutic use, Y56.4 Keratolytics, keratoplastics and other hair treatment drugs and preparations, is only applicable for those indexed substances being used for therapeutic purposes. The scenario in the query does not indicate any therapeutic purpose.
Published15 March 2016,for implementation 01 April 2016.
Ref No: TN1033 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Admission for donor apheresis
Q:
Can Z51.81 Apheresis be assigned for a patient admitted to donate their cells via apheresis?
A:
Apheresis (haemapheresis) is the process of removing whole blood, extracting a specific component from the blood and then reinfusing into the donor. A number of terms may be used to describe the specific cells being extracted, for example:
•plasmapheresis – extraction of plasma
•leukapheresis – extraction of leukocytes (white blood cells)
•plateletpheresis – extraction of platelets
Allogeneic donor apheresis is a healthy donor admitted to donate cells for infusion into another person. The target cells are harvested and the unused portion of the blood is reinfused into the donor. Assign as principal diagnosis:
Z51.81 Apheresis
Autologous donor apheresis is when a patient with a known disease such as a malignancy is admitted to donate their own cells for therapeutic reinfusion at a later stage. Assign as principal diagnosis the condition that will be treated by the donated cells.
Do not assign Z51.81 in this scenario; the apheresis will be identified by the assignment of an appropriate ACHI code from block [1892] Apheresis.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q2966 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Postprocedural wound dehiscence
Q:
What is the correct code to assign for a wound dehiscence following insertion of a prosthetic device, implant or graft?
A:
Assign T81.3 Disruption of operation wound, not elsewhere classified, for postprocedural wound dehiscence, following the index pathway:
Dehiscence
- postprocedural NEC T81.3
Disregard the Excludes note at T81 Complications of procedures, not elsewhere classified which excludes
complications of prosthetic devices, implants and grafts (T82–T85)
in this instance as T81.3 provides more specificity than a residual code at T82-T85 Complications of prosthetic devices, implants and grafts.
The classification of procedural complications is currently under review.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q2972 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Traumatic neuroma due to surgery
Q:
What is the correct diagnosis code to assign for a traumatic neuroma due to surgery?
For example, a patient was admitted post brow lift with wound swelling. The wound was excised and the histopathology report found traumatic neuroma.
A:
The correct code to assign for traumatic neuroma due to surgery in the scenario cited is G97.8 Other postprocedural disorders of the nervous system following the index pathway:
Complication
- nervous system
- - postprocedural
- - - specified NEC G97.8
ACS 1904 Procedural complications states:
An additional code from Chapters 1 to 19 should be assigned where it provides further specificity.
In the scenario cited, no additional code provides further specificity and thus no additional code is assigned.
ACS 1904 Procedural complications is currently under review forICD-10-AM Tenth Edition.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q2982 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Hyperbaric oxygen therapy
Q:
Should multiple codes be assigned for hyperbaric oxygen therapy if performed multiple times within an episode?
A:
The codes for hyperbaric oxygen therapy are based on the duration of each session. Assign multiple codes to represent the number of sessions based on the duration of each session not the cumulative duration and irrespective of the condition being treated.
ACS 0020 Bilateral/multiple procedures states that
A procedure which is repeated during the episode of care at different visits to theatre should be coded as many times as it is performed.
Theatre should be interpreted as an operating theatre or any other place where a procedure is performed during an inpatient episode of care.
Therefore the following codes should be assigned as many times as they are performed, based on the time per session, within an episode of care:
96191-00 [1888] Hyperbaric oxygen therapy, ≤90 minutes
13020-00 [1888] Hyperbaric oxygen therapy, > 90 minutes and ≤3 hours
13025-00 [1888] Hyperbaric oxygen therapy, > 3 hours.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q2983 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Tobacco dependence
Q:
What is the correct code to assign for documentation of tobacco dependence (without the term syndrome documented) and does the advice also apply to alcohol and other drugs?
A:
ACS 0503 Drug, Alcohol and Tobacco Use Disorders states:
Importantly, it should be noted that documentation such as 'on patches' or 'trying to quit' are not justification to classify to the dependence syndrome. The dependence syndrome is defined as a cluster of phenomena … and therefore it is important that a clinical decision to classify a case to this code is made based on that evidence and not because society in general regards all smokers asdependent.
Dependence, addiction ordependence syndromemust be documented before F10-F19 with fourth character .2 can be assigned. F17.2 Tobacco dependence syndrome is assigned following index pathways:
Dependence
- due to
- - nicotine F17.2
- - tobacco F17.2
- syndrome — code to F10–F19 with fourth character .2
This rationale also applies to alcohol and other drugs ie dependence, addiction or dependence syndromemust be documented before assigning an appropriate code from F10-F19 with fourth character code .2 dependence syndrome.
The misleading statement above Example 8 in ACS 0503 Drug, alcohol and tobacco use disorders will be revised as part of errata 4 to Ninth Edition as follows:
F17.2 Tobacco dependence syndrome
Assign this code if the patient is diagnosed as having tobacco dependence (syndrome).
ACS 0503 Drug, Alcohol and Tobacco Use Disorders is currently under review for ICD-10-AM Tenth Edition.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q3003 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Respiratory acidosis in a diabetes mellitus patient
Q:
What is the correct code assignment for respiratory acidosis ina patient with diabetes mellitus?
A:
Respiratory acidosis is a metabolicderangementofacid-basebalance where thebloodpHis abnormallylow. Respiratory acidosiswill occur if thelungsare not ventilating properly resulting in anexcessofcarbon dioxidein thebody (Mondofacto, 1999).
Respiratory acidosis may have a variety of different causes, including:
•COPD
•Neuromuscular diseases
•Chest wall disorders
•Obesity-hypoventilation syndrome
•Obstructive sleep apnoea (OSA)
•Central nervous system (CNS) depression
•Other lung and airway diseases (Medscape, 2015).
ICD-10-AM does not assume a causal link between diabetes mellitus and respiratory acidosis when both are documented.
ICD-10-AM does however assume a causal link where there is documentation of lactic acidosis or ketoacidosis as per the index pathway below:
Diabetes, diabetic
- with
- - acidosis— see alsoDiabetes/with/ketoacidosis
- - - lactic (without coma)E1-.13
- - - - with comaE1-.14
- - - - and ketoacidosis (without coma)E1-.15
- - - - - with comaE1-.16
For a patient with respiratory acidosis and diabetes mellitus assign:
E87.2Acidosisfollowing the index below with the appropriate diabetes mellitus code and sequence according to ACS 0001 Principal diagnosis and ACS 0002 Additional diagnoses.
Acidosis(lactic) (respiratory)E87.2
See also Coding Rule, Metabolic acidosis in a diabetes mellitus patient, published 15 September 2015.
References:
Mondofacto online medical dictionary, 25 Jun 1999, viewed 24 February 2016
Byrd, RP Jr, ‘Respiratory Acidosis’, Medscape, 31 July 2015, viewed 4 March 2016
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q3006 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Diabetes mellitus in pregnancy
Q:
Does diabetes mellitus have to be documented as complicating the pregnancy before assigning a code from O24 Diabetes mellitus in pregnancy?
A:
When a pregnant patient is admitted with diabetes mellitus, assign an appropriate code from O24 Diabetes mellitus in pregnancy; there does not need to be documentation that the diabetes mellitus is complicating the pregnancy.
See ACS 0001 Principal diagnosis/Obstetrics for guidelines regarding sequencing in antepartum and delivery episodes.
The classification of complications of pregnancy is being reviewed for Tenth Edition.
Published15 March 2016,for implementation 01 April 2016.
Coding Rules - Current as at 16-Mar-2016 03:51 / Page 1 of 22Australian Consortium for Classification Development / ACCD Classification Information Portal
Ref No: Q3010 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Nasendoscopy with view to the larynx
Q:
What is the correct code to assign for a nasendoscopy with views to the larynx? Should the instruction in ACS 0024 Panendoscopy to code to the furthest site viewed be applied to assign a code for laryngoscopy?
A:
Panendoscopy is a generic term for an endoscopy of the upper gastrointestinal tract (ie oesophagus, stomach and duodenum) or aerodigestive tract (ie pharynx, larynx, upper oesophagus). ACS 0024 Panendoscopy states:
The term panendoscopy can also be used to mean endoscopies of the respiratory tract and the urinary system and therefore nongastrointestinal endoscopies should be coded appropriately, to the furthest site viewed
This advice only applies where the term panendoscopy is documented. Where specific types of endoscopes (nasendoscopy, laryngoscopy) are documented these should be coded as such. For example, if documentation indicates a nasendoscopy with views to the larynx has been performed, assign 41764-00 [370]Nasendoscopy. A separate code from block [520]Examination procedures on larynx should be assigned if documentation indicates a laryngoscopy has also been performed.
Published15 March 2016,for implementation 01 April 2016.
Coding Rules - Current as at 16-Mar-2016 03:51 / Page 1 of 22Australian Consortium for Classification Development / ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 April 2016
Ref No: Q3011 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: ACS 0503 Drug, Alcohol and Tobacco Use Disorders and the application instructions for harmful use
Q:
A patient is admitted with UTI. In the medical history it has been documented that the patient has smoking related COPD; now an exsmoker.
Should F17.1Mental and behavioural disorders due to use of tobacco, harmful use or Z86.43 Personal history of tobacco use disorder be assigned?
Should COPD be assigned if it does not meet ACS 0002 Additional diagnoses?
A:
The guidelines in ACS 0503 Drug, Alcohol and Tobacco Use Disorders/Classification/General (below) state:
Where the clinician has clearly documented a relationship between a particular condition(s) and alcohol/drug use, assign a code for the specific condition (see Alphabetic Index), with the appropriate code from F10–F19. Such documentation includes qualifying statements such as 'alcohol-induced' or 'drug-related', or 'CAL/smoker' indicating evidence that the substance use was responsible for (or substantially contributed to) physical or psychological harm. Sequencing should be determined by following the classification guidelines in ACS 0001 Principal diagnosis and ACS 0002 Additional diagnoses.
There is no explicit ‘always code’ instruction within ACS 0503, and as such the condition itself must meet the criteria in ACS 0002 Additional diagnoses in orderto be assigned in conjunction with an appropriate code from F10-F19.
Irrespective of whether or not the condition itself meets the criteria in ACS 0002 Additional diagnoses for code assignment, F17.1 Mental and behavioural disorders due to use of tobacco, harmful use is the correct code to assign for the scenario cited.
Z86.43 Personal history of tobacco use disorder is not to be assigned in addition to F17.1 Mental and behavioural disorders due to use of tobacco, harmful use as per the Excludes note at Z86.43 Personal history of tobacco use disorder.
ACS 0503 Drug, Alcohol and Tobacco Use Disorders is being reviewed for ICD-10-AM Tenth Edition.
Published15 March 2016,for implementation 01 April 2016.
Coding Rules - Current as at 16-Mar-2016 03:51 / Page 1 of 22Australian Consortium for Classification Development / ACCD Classification Information Portal
Ref No: Q3017 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: ACS 0002 Additional diagnoses and alteration to treatment - Part 2
Q:
Should a condition be assigned as an additional diagnosis whenever medication is altered or only when the medication is altered for management of that condition (ie not management of a side effect). The Coding Rules Anticoagulation monitoring (15 June 2010) and ACS 0002 Additional diagnoses and alteration to treatment (15 June 2015) appear to contradict.
A:
The advice published 15 June 2010, Anticoagulation monitoring, is still current and should be followed i.e. assign Z92.1Personal history of long term (current) use of anticoagulantsto reflect alteration to anticoagulants as detailed in the Coding Rule. However, the advice is specific to anticoagulants and should not be applied to other conditions or scenarios. Changes to the classification of anticoagulation therapy are being implemented for Tenth Edition when this advice will be retired.
Where medication to treat a specific condition is altered during an episode of care, assign an additional diagnosis code for the condition by following the criteria in ACS 0002 Additional diagnoses, dot point 1, which states:
For coding purposes, additional diagnoses should be interpreted as conditions that affect patient management in terms of requiring any of the following:
- commencement, alteration or adjustment of therapeutic treatment
Although alteration to medication may be related to management of a side effect of the medication, the therapeutic treatment of the condition is still being altered and so meets the criterion above to be assigned as an additional diagnosis.
A review of the criteria for assignment of additional diagnoses in ACS 0002 is planned for the future, following analysis of the Supplementary codes for chronic conditions (U codes) data.
Published15 March 2016,for implementation 01 April 2016.
Coding Rules - Current as at 16-Mar-2016 03:51 / Page 1 of 22Australian Consortium for Classification Development / ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 April 2016
Ref No: Q3024 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Endoscopic pilonidal sinus treatment (EPSiT)
Q:
How do you code endoscopic pilonidal sinus treatment (EPSiT)?
A:
Endoscopic pilonidal sinus treatment (EPSiT) is a video-assisted minimally invasive treatment for pilonidal sinus. The aim of EPSiT is to clean and ablate an infected sinus tract, to promote healing and prevent recurrence.
EPSiT is performed by incising a small circular area around the external opening of the pilonidal sinus. Insertion of a ‘fistuloscope’ (an endoscopic instrument inserted into the fistula/sinus) provides visualization. Hair particles and debris within the sinus are removed using forceps. Sinus granulation tissue is ablated (cauterised) using a monopolar electrode connected to an electrosurgical knife. A continuous infusion of glycine/mannitol solution is used to assist with removal of the ablated/cauterised tissue. Necrotic material may also be removed using an endobrush via the fistuloscope (or Volkmann spoon for superficial waste). Mesh and a fibrin sealant may be sutured at the sinus opening prior to application of an external dressing.
For classification of endoscopic pilonidal sinus treatment (EPSiT), assign:
30676-00 [1659]Incision of pilonidal sinus or cyst
by following the index pathway:
Incision
- pilonidal sinus (cyst) 30676-00 [1659]
Additional codes for the various components of the procedure (eg endoscopy/fistuloscopy, insertion of mesh/fibrin sealant, ablation of pilonidal fistula tissue) are not assigned:
- as per the guidelines in ACS 0016 General procedure guidelines/procedure components and
- as there is no code for fistuloscopy in ACHI.
Enhancements to ACHI will be considered for a future edition.
Published15 March 2016,for implementation 01 April 2016.
Ref No: Q3025 | Published On: 15-Mar-2016 | Status: Current
SUBJECT: Small versus extensive split skin grafts
Q:
Are there any definitions or criteria in ACHI for the terms small and extensive split skin grafts?
A:
The terms small, extensive and granulating are included in ACHI codes due to the MBS item descriptors that they are based on:
•45400 FREE GRAFTING (split skin) of a granulating area, small
•45403 FREE GRAFTING (split skin) of a granulating area, extensive
•45439 FREE GRAFTING (split skin) to 1 defect, including elective dissection, small
•45442 FREE GRAFTING (split skin) to 1 defect, including elective dissection, extensive
These terms are applied in ACHI differently for split skin graft (SSG) to burn and non-burn wounds.
Split skin graft to burn
Codes for SSG to burn are located in blocks:
•[1643]Split skin graft to burn of specific sites
•[1641]Split skin graft to granulating burn site.
The terms small and extensive for SSG to burn are only applicable to block [1641]:
•small is applicable to (unspecified or) < 3% of body surface area (BSA) grafted:
45400-01 [1641] Split skin graft of small granulating burn site, 3% of body surface area grafted
•extensive is applicable to ≥3% of BSA grafted:
45403-01 [1641] Split skin graft of extensive granulating burn site, ≥3% of body surface area grafted
as per the index pathways:
Graft
- skin
- - for burn
- - - specified site NEC
- - - - split thickness
- - - - - granulating (< 3% body surface area) 45400-01 [1641]
------≥3% body surface area grafted 45403-01 [1641]
(See also Split skin graft to granulating area, below).
Split skin graft to non-burn wounds
Codes for SSG of non-burn wounds are located in blocks:
•[1645] Other split skin graft, small,
•[1646] Other split skin grafts, extensive
•[1642] Other split skin graft to granulating area.
There are no definitions or criteria in ACHI for small and extensive SSG to non-burn wounds. Where these terms are not documented in the clinical record/operation report, clinical coders should clarify with clinicians to determine if a grafted area is small or extensive, or apply the guidelines in ACS 0038 Procedures distinguished on the basis of size, time, number of lesions or sites: