Ref No: Q2907 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Procedures performed in radiology departments
Q:
Do you need to code procedures performed in privately owned/off site radiology departments?
A:
The purpose of the Admitted Patient Care National Minimum Data Set (APC NMDS) is to collect information about care provided to admitted patients in Australian hospitals.
Procedures performed while a patient is formally admitted should be coded (where they meet the criteria in ACS 0016 General procedure guidelines),irrespective of whether the facility subcontracts another department to perform the procedures, as they are still performed as part of the admitted episode of care.
However, a procedure qualifying for code assignment should not be coded if performed in another facility where the patient has been placed on leave from the admitting facility and admitted to another facility to have the procedure performed.
Additionally, procedures qualifying for code assignment performed in other facilities under a contractual arrangement should be coded as per the guidelines in ACS 0029 Coding of contracted procedures:
If a hospital treatment is carried out under a contracting arrangement existing between two hospitals, all procedures carried out under the contract are to be recorded and coded in both hospitals. The hospital not carrying out the procedure should flag the appropriate code.
Reference:
Australian Institute of Health and Welfare. (2014). METeOR Metadata online registry. Retrieved from
(Coding Rules, September 2015)
Coding Rules - Current as at 16-Sep-2015 06:23 / Page 1 of 27Australian Consortium for Classification Development / ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 October 2015
Ref No: Q2869 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Application of ACS 0046 Diagnosis selection for same-day endoscopy
Q:
Could the application of ACS 0046 Diagnosis selection for same-day endoscopy please be clarified for the following scenarios:
Scenario 1: Patient admitted (same-day) for colonoscopy due to +FOBT. Diverticular disease and ulcerated sigmoid polyp was found. Sigmoid polyp was excised and sent to pathology. Histopathology report confirmed adenocarcinoma arising in adenoma.
Scenario 2: Patient with haemoptysis admitted for bronchoscopy/biopsy. Histopathology confirms carcinoma of the left lung.
Scenario 3: Patient with haematuria admitted for cystoscopy/biopsy. Histopathology confirms TCC of the bladder.
A:
ACS 0046 Diagnosis selection for same-day endoscopy was developed to provide coding instruction for same-day endoscopy episodes of care where conditions/findings are frequently documented without a causal link by the clinician. It applies to all episodes of care for same-day endoscopy except where specifically excluded in ACS 0046 as follows:
•“Cases where the patient is presenting for follow-up investigations. These cases are coded in accordance with ACS 2113Follow-up examinations for specific disorders.
•Patients having endoscopies to further investigate a known condition, such as carcinoma of the stomach (these cases will be coded in accordance with ACS 0001Principal diagnosis and ACS 0002Additional diagnoses), or those presenting with a problem related to a known condition (these will be coded in accordance with ACS 0001Principal diagnosis).
•Episodes for screening that are coded in accordance with ACS 2111Screening for specific disorders. “
Dot point one refers to same-day endoscopies to follow up conditions previously treated, thought to be cured or healed, but for which an endoscopy is performed to check for recurrence of the condition (sometimes referred to as a check endoscopy).Refer toACS 2113 Follow-up examinations for specific disorders.
Dot point two refers to same-day endoscopies to further investigate/follow-up a current or chronic condition, such as current carcinoma of the stomach, coeliac disease etc. Refer to ACS 0001 Principal diagnosis and ACS 0002 Additional diagnoses.
Dot point three refers to same-day endoscopies to screen for conditions that individuals are at risk of developing e.g. family history of bowel cancer. Refer to ACS 2111 Screening for specific disorders.
With respect to the scenarios cited, the first is noted to be a same-day endoscopy episode of care and therefore the principles in ACS 0046 Diagnosis selection for same-day endoscopy apply.
The second and third scenarios do not indicate whether they are same-day endoscopy episodes of care. If they are, ACS 0046 Diagnosis selection for same-day endoscopy applies as per the first scenario, otherwise ACS 0001 Principal diagnosis applies.
In all the scenarios cited, there is a statement that histopathology confirms a diagnosis of cancer, however, unless that confirmation is documented by or verified by the clinician then a causal link has not been established and the symptom should be assigned as the principal diagnosis and any findings as additional diagnoses.
The classification of same-day endoscopies is currently under review.
(Coding Rules, September 2015)
Ref No: Q2905 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Coding of allergic reactions NOS and anaphylactic reactions
Q:
How should allergic reactions not otherwise specified (NOS) and anaphylactic reactions be coded? Should symptom codes be assigned for allergic reactions?
A:
The correct code assignment for allergic reactions NOS and anaphylactic reactions are outlined below.
Allergic reaction NOS:
T78.4 Allergy, unspecified following the guidelines in ACS 2004 Allergic reaction NOS and the index pathway:
Allergy, allergic (reaction) T78.4
Allergic reaction NOS to food:
T78.1 Other adverse food reactions, not elsewhere classified following the index pathway:
Allergy, allergic (reaction)
- food (any) (ingested) NEC T78.1
Anaphylaxis due to food:
T78.0 Anaphylactic shock due to adverse food reaction following the index pathway:
Allergy, allergic (reaction)
- food (any) (ingested) NEC
- - anaphylactic shock T78.0
When assigning a code classified to category T63 Toxic effect of contact with venomous animals additional codes should be assigned for any associated allergic reaction as per the instructional note at this category.
Symptoms such as wheeze, urticaria and swelling should not be coded when a diagnosis of allergic reaction or anaphylaxis has been established unless the symptom is significant in its own right and treated independently of the allergic reaction following the guidelines in ACS 1802 Signs and symptoms.
Assign external cause codes as appropriate.
ACCD will consider improvements to the classification for a future edition.
(Coding Rules, September 2015)
Ref No: Q2917 | Published On: 15-Sep-2015 | Status: Current
Subject: Injury and external cause codes for leech bite
Q:
What injury and external cause codes should be assigned for a leech bite on the ankle?
A:
Leeches belong to the family of Annelids (segmented worms) that live on land as well as in water; and are not insects. They attach themselves to a host using suckers and then bite into the host using their teeth. They release an anaesthetic in their saliva which prevents the host from feeling them as well as an anti-coagulant called hirudin which keeps the blood flowing. Leeches carry a bacterium in their gut known as Aeromonashydrophiliawhich can then infect the host through the bite.
The following injury and external cause codes for a leech bite on the ankle should be assigned:
S91.0 Open wound of ankle
following the index entries:
Bite(s)
- animal (see also Wound, open) T14.1
then
Wound, open (animal bite) (cut) (laceration) (puncture wound) (shot wound) (with penetrating foreign body)
- ankle S91.0
Assign W64 Exposure to other and unspecified animate mechanical forces following the index entry:
Bite, bitten by — see also Contact/with/by type of bite
- animal NEC W64
with appropriate activity and place of occurrence codes.
Code and sequence any associated cellulitis, infection and infectious agent(s) as per ACS 0001 Principal diagnosis and ACS 0002 Additional diagnoses.
(Coding Rules, September 2015)
Ref No: Q2928 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Coblation of the laryngotrachea
Q:
How do you code coblation of the laryngotrachea?
A:
Coblation (cold or controlled ablation) of the laryngotrachea is a destruction procedure most commonly performed for the treatment of papillomatosis.
Coblation of the laryngotrachea is an endoscopic procedure, usually performed with a microlaryngoscope, however it may also be performed using a bronchoscope extended to the laryngotracheal region.
Although there is no specific block for destruction procedures on the larynx and/or trachea in ACHI, endoscopic excision procedures on the larynx and/or trachea are classified to block [523]Laryngoscopy with excision (which includes tracheoscopy).
Therefore, where coblation of the laryngotrachea is performed, assign either:
41852-00 [523] Laryngoscopy with removal of lesion
OR
41864-00 [523]Microlaryngoscopy with removal of lesion
as a best fit, by following the index pathway:
Endoscopy, endoscopic (double balloon)
- larynx
- - with removal of lesion 41852-00[523]
OR
Destruction
- lesion (tumour)
- - larynx
- - - with microlaryngoscopy 41864-00 [523]
Enhancements to ACHI will be considered for a future edition.
(Coding Rules, September 2015)
Ref No: Q2930 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Metabolic acidosis in a diabetes mellitus patient
Q:
What is the correct code assignment for metabolic acidosis ina patient with diabetes mellitus?
A:
Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body. The different types of metabolic acidosis are:
•Diabetic acidosis (also called diabetic ketoacidosis and DKA) which develops when acidic substances known as ketone bodies build up in the body. This commonly occurs with uncontrolled type 1 diabetes mellitus but can occur with type 2 diabetes mellitus.
•Hyperchloraemic acidosis which results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhoea.
•Lactic acidosis results froma buildup of lactic acid. It can be caused by alcohol, diabetes, cancer, exercising intensely, liver failure, medications, such as salicylates, prolonged lack of oxygen from shock, heart failure, severe anaemia and seizures.
Other causes of metabolic acidosis include:
•Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis)
•Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol
•Severe dehydration
(National Institute of Health, 2013).
ICD-10-AM does not assume a causal link between diabetes mellitus and metabolic acidosis NOS when both are documented. However, it does assume a causal link where there is documentation of lactic acidosis or ketoacidosis as per the index pathway below:
Diabetes, diabetic
- with
- - acidosis — see also Diabetes/with/ketoacidosis
- - - lactic (without coma) E1-.13
- - - - with coma E1-.14
- - - - and ketoacidosis (without coma) E1-.15
- - - - - with coma E1-.16
Clarification should be sought from the treating clinician as to the specific type of metabolic acidosis to assign E1-.13 – E1-.16. When clarification is not possible, assign E87.2 Acidosis following the index pathway:
Acidosis (lactic) (respiratory) E87.2
- diabetic — see Diabetes/with/acidosis
- metabolic NEC E87.2
Improvements to ICD-10-AM Alphabetic Index will be considered for a future edition.
References:
National Institute of Health (2013). Metabolic acidosis. Retrieved from:
The Merck Manual. (2013). Metabolic acidosis. Retrieved from:
(Coding Rules, September 2015)
Ref No: Q2932 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Transmastoid repair of tegmen defect with ossicular chain reconstruction (OCR)
Q:
What is the correct procedure code for transmastoid repair of tegmen defect with ossicular chain reconstruction (OCR)?
A:
Transmastoid repair of tegmen defect is a surgical repair of the bony defect of tegmen (part of the temporal bone) with a piece of auricular cartilage via a mastoidectomy. The bony defect is usually the result of a lesion such as a cholesterol granuloma or other disease process. The procedure involves a classical incision behind the ear with removal of part of the bony wall of the mastoid to allow the surgeon to remove the lesion and/or access the bony defect with direct visualisation. Once the tegmen defect is identified, a cartilage graft is harvested and placed in the defect area. Reshaping of patient’s existing bone (i.e. ossicular chain reconstruction) or repositioning of the prosthetic bone (e.g. partial ossicular replacement prosthesis) may be performed as needed.
A transmastoid repair of tegmen defect with ossicular chain reconstruction (OCR) is also described as a ‘canal wall up mastoidectomy’ meaning the external auditory canal is kept intact i.e. an intact canal wall technique is used.
Therefore the correct code for this procedure is 41554-00 [326]Mastoidectomy by intact canal wall technique with myringoplastyand ossicular chain reconstruction, following the index pathway:
Mastoidectomy(cortical) (simple)
- intact canal wall technique (with atticotomy)
- - with myringoplasty
- - - and ossicular chain reconstruction (graft) (prosthesis) 41554-00[326]
If a mastoidectomy is described as ‘canal wall down’, it includes a complete mastoidectomy in addition to removal of the posterior auditory canal (i.e. not an intact canal wall technique). For these procedures clarification is required as to whether the procedure is a modified radical mastoidectomy or a radical mastoidectomy. Assign an appropriate mastoidectomy code by following the index pathway:
Mastoidectomy(cortical) (simple)
- modified radical
…
- radical
Improvements to ACHI will be considered for a future edition.
References:
Isaacson, B 2013, Mastoidectomy, Medscape, viewed 12 May 2015,
Patel, NS, Canopy, E and Sheykholeslami, K 2013, Trans-Mastoid Management of Temporal Bone Tegmen Defects, Encephaloceles and CSF Leaks, J OtolRhinol 2:1, doi:10.4172/2324-8785.1000109.
(Coding Rules, September 2015)
Ref No: Q2940 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Fractional flow reserve (FFR)
Q:
What is the correct procedure code for ‘fractional flow reserve (FFR)’ measurement?
A:
FFR is the measurement of blood flow in a coronary artery at resting and maximal perfusion to determine functional significance of a coronary artery stenosis. The measurement is usually coupled with coronary angiography and/or angioplasty but it may be performed independently.
FFR measurement is obtained by using a pressure wire inserted into the coronary artery through a sheath. A vasodilatory medication such as adenosine is infused to achieve maximal coronary perfusion. Pressure readings and pressure ratio are recorded to determine the FFR value.
Currently ACHI does not contain a specific procedure code for FFR, however, as it is commonly performed in conjunction with coronary angiography assign an appropriate code from block [668]Coronary angiography, by following the index pathway:
Angiography
- coronary
A unique code for FFR will be considered for a future edition of ACHI.
References:
Shantouf,R. S. andMehra A. (2015). Coronary fractional flow reserve. American Journal of Roentgenology.204:3,W261-W265.
(Coding Rules, September 2015)
Ref No: Q2942 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Congestive cardiac failure (CCF) and left ventricular failure (LVF)
Q:
How do you code congestive cardiac failure (CCF) and left ventricular failure (LVF)?
A:
The following codes should be assigned for congestive heart/cardiac failure (CHF/CCF) and left ventricular failure (LVF):
Assign I50.0 Congestive heart failure for:
•CHF/CCF with or without acute pulmonary oedema
•CHF/CCF with LVF
Assign I50.1 Left ventricular failure for:
•LVF without mention of CHF/CCF
•Acute pulmonary oedema with mention of heart disease or non-congestive heart failure
See also ACS 0920 Acute pulmonary oedema.
Improvements to ICD-10-AM and the ACS will be considered for a future edition.
(Coding Rules, September 2015)
Ref No: Q2946 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Haemodialysis associated steal syndrome
Q:
How do you code haemodialysis associated steal syndrome?
A:
Haemodialysis associated steal syndrome is a complication occurring in 6% of haemodialysis patients with a functioning arteriovenous (AV) fistula or graft. There is an imbalance between the low-resistance blood flow of the AV access and the high-resistance blood flow in the distal, arterial vasculature of the forearm and hand resulting in symptoms of poor blood supply such as hand pain, coldness and even digital gangrene. The lack of blood supply is due to:
•existing arterial insufficiency such as atherosclerosis and stenosis of the subclavian, axillary, and brachial artery proximal to an AV access, or distal arteriopathy, particularly in diabetes mellitus patients
•having too much blood flow through the AV fistula
•a combination of the above factors.
For steal syndrome in a patient with AV fistula or graft for dialysis, assign T82.8 Other specified complications of cardiac and vascular prosthetic devices, implants and grafts following the index pathway:
Complications (from) (of)
- arteriovenous fistula or shunt, surgically created
- - infection or inflammation
- - mechanical
- - specified NEC T82.8
with
Y84.1 Kidney dialysis as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure
Y92.22 Health service area.
Enhancements to ICD-10-AM will be considered for a future edition.
References:
Berman S, (2009). Understanding Steal Syndrome: Causes and Prevention. Endovascular today. Retrieved from:
Leon C. and Asif, A. (2007). Arteriovenous Access and Hand Pain: The Distal Hypoperfusion Ischemic Syndrome. Clinical Journal of the American Society of Nephrologist. Retrieved from:
(Coding Rules, September 2015)
Ref No: Q2948 | Published On: 15-Sep-2015 | Status: Current
SUBJECT: Panniculitis and calcific (uraemic) arteriolopathy (calciphylaxis)
Q:
How do you code panniculitis and calcific uraemic arteriolopathy (calciphylaxis), when a patient presents with both conditions during an episode of care?
A:
Panniculitis is broad term for inflammatory disorders of subcutaneous adipose (fat) tissue; lobular panniculitis is one of two types, and is further described as with or without vasculitis. Calcific (uraemic) arteriolopathy/calciphylaxis is sometimes classified as a type of ‘mostly lobular panniculitis without vasculitis’. However, it is also described as a completely separate entity to panniculitis, although the conditions are often seen together.
The following are definitions for these conditions:
Calcific (uraemic) arteriolopathy (calciphylaxis) is a life-threatening vasculopathic disorder characterized by painful cutaneous ischaemia and infarction due to calcification, intimal fibroplasia, and thrombosis of subcutaneous arterioles. It is most commonly associated with end-stage kidney disease or renal transplantation, particularly in the context of longstanding diabetes mellitus. Affected skin, commonly on the hips and thighs, appears mottled, grey and devitalized before progressing to full thickness infarction and deep ulceration. These changes may be accompanied by indurated subcutaneous plaques indicating an underlying calcifying panniculitis. The condition may be but is not always associated with hyperparathyroidism or an elevated calcium-phosphate product.