coding rules - current as at 16-mar-2016 03:51

Australian Consortium for Classification DevelopmentACCD Classification Information

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Coding Rule is effective for event records with an event end date on or after 1 April 2016Ref 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.

Published 15 March 2016, for implementation 01 April 2016.

Coding Rules - Current as at 16-Mar-2016 03:51 of 22


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Coding Rule is effective for event records with an event end date on or after 1 April 2016Ref 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:

1. plasmapheresis – extraction of plasma2. leukapheresis – extraction of leukocytes (white blood cells)3. 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.




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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 excludescomplications 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.




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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 for ICD-10-AM Tenth Edition.




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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.




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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 as dependent.

Dependence, addiction or dependence syndrome must 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 syndrome must 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.




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SUBJECT: Respiratory acidosis in a diabetes mellitus patient

Q: What is the correct code assignment for respiratory acidosis in a patient with diabetes mellitus?

A:Respiratory acidosis is a metabolic derangement of acid-base balance where the blood pH is abnormally low. Respiratory acidosis will occur if the lungs are not ventilating properly resulting in an excess of carbon dioxide in the body (Mondofacto, 1999).Respiratory acidosis may have a variety of different causes, including:

1. COPD 2. Neuromuscular diseases 3. Chest wall disorders 4. Obesity-hypoventilation syndrome5. Obstructive sleep apnoea (OSA)6. Central nervous system (CNS) depression 7. 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 also Diabetes/with/ketoacidosis- - - lactic (without coma) E1-.13- - - - with coma E1-.14- - - - and ketoacidosis (without coma) E1-.15- - - - - with coma E1-.16

For a patient with respiratory acidosis and diabetes mellitus assign:

E87.2 Acidosis following 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 http://www.mondofacto.com/facts/dictionary?respiratory%20acidosisByrd, RP Jr, ‘Respiratory Acidosis’, Medscape, 31 July 2015, viewed 4 March 2016 http://emedicine.medscape.com/article/301574-overview#a7




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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.




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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.



NOT APPLICABLE TO NEW ZEALAND FOR THE DURATION OF 8TH EDITION


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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 F17.1 Mental 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 order to 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.




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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 Z92.1 Personal history of long term (current) use of anticoagulants to 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.



NOT APPLICABLE TO NEW ZEALAND FOR THE DURATION OF 8TH EDITION


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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 cystby 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.




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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:

1. 45400 FREE GRAFTING (split skin) of a granulating area, small2. 45403 FREE GRAFTING (split skin) of a granulating area, extensive3. 45439 FREE GRAFTING (split skin) to 1 defect, including elective dissection, small4. 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:

1. [1643] Split skin graft to burn of specific sites2. [1641] Split skin graft to granulating burn site.

The terms small and extensive for SSG to burn are only applicable to block [1641]:

3. 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

4. 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:

5. [1645] Other split skin graft, small, 6. [1646] Other split skin grafts, extensive



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Coding Rule is effective for event records with an event end date on or after 1 April 20167. [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:

Where there is no documentation in the clinical record, no further information can be obtained from the clinician and there is no default in the index, assign the code for the smallest size, the least duration, the least number of lesions or sites, as appropriate.

Split skin graft to granulating areaAlthough there is no definition in ACHI for granulating area, the clinical definition is healing skin/tissue; granulation tissue is a normal part of the wound healing process. For some wounds, particularly burns, the process of granulation is undesirable, as granulation tissue is excessively vascular and therefore prone to haemorrhaging. Granulation tissue may also cause shrinkage at the burn/wound site and may slow the rate of healing. As a result, granulation tissue may require surgical removal and application of grafted skin to promote healing and avoid localised blood loss. ACHI codes for SSG to non-burn wound specifying granulating area are only assigned when this term is documented, or following advice from a clinician.

Assign either of the following codes for SSG to granulating area of a non-burn wound (see above for advice regarding assignment of SSG to granulating burn site):

45400-00 [1642] Split skin graft of small granulating area45403-00 [1642] Split skin graft of extensive granulating area

Follow the index pathways:

Graft- skin- - granulating area- - - extensive 45403-00 [1642]- - - small 45400-00 [1642](See above for advice regarding the terms small and extensive).

Amendments to the indexing of SSG for burn and non-burn wounds will be considered for a future edition of ACHI.

References:Burn Centre Care 2006, ‘Problems due to burned skin’, viewed 7 December 2015, http://burncentrecare.co.uk/complications_burn_wounds.htm

Clinimed 2014, ‘Phases of wound healing’, viewed 7 December 2015, http://www.clinimed.co.uk/Wound-Care/Education/Wound-Essentials/Phases-of-Wound-Healing.aspx

MedicineNet Inc 2015, ‘Definition of granulation’ , viewed 7 December 2015, http://www.medicinenet.com/script/main/art.asp?articlekey=11385




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SUBJECT: Wound debridement

Q:Can a debridement of a wound in theatre be coded as a soft tissue debridement?

A:ACS 1203 Debridement, states:

1. most debridements are excisional 2. check with the clinician if unsure 3. use the nonexcisional code if documentation/clinical advice supports its use

Therefore, a wound taken to theatre for debridement is assumed to be excisional unless there is documentation or clinical advice that supports assignment of a code for nonexcisional debridement. The advice in ACS 1203 effectively defaults classification of wound debridement to excisional. However, there is no default position as to whether the excisional debridement is of soft tissue or skin and subcutaneous tissue.

ACS 1331 Soft tissue injuries defines soft tissue (deep tissue) as tissue that:

connects, supports or surrounds other structures and organs of the body. Soft tissue includes muscles, nerves, tendons, fat, blood or lymph vessels, fasciae and tissue around joints (synovial tissue) (that is, all tissue excluding skin, subcutaneous tissue, cartilage and bone).Where documentation in the clinical record, in particular the operation report, states that debridement was of ‘soft tissue’, ‘deep tissue’ or soft tissue structures assign 30023-00 [1566] Excisional debridement of soft tissue by following the index pathway:

Debridement- soft tissue, excisional NEC 30023-00 [1566]

In the absence of documentation to support that any deep or soft tissue structures have been debrided, or if only subcutaneous tissues are documented as having been debrided (and there is no indication it is nonexcisional), assign 90665-00 [1628] Excisional debridement of skin and subcutaneous tissue by following the index pathway:

Debridement- skin- - excisional 90665-00 [1628]




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SUBJECT: E-cigarettes and waterpipes

Q:Should the use of alternative smoking devices such as e-cigarettes and shisha be coded to Z72.0 Tobacco use, current when their use meets the definition of ‘current use’? Do they also qualify for assignment of codes from category F17 Mental and behavioural disorders due to use of tobacco?

A:Electronic cigarettes (e-cigarettes, green cig, e-shisha, vape-pipes) and waterpipes (hookah, narghile, shisha) are increasingly popular alternatives to cigarette smoking. Electronic cigarettes are an electronic nicotine delivery system (ENDS). The device includes a replaceable cartridge containing nicotine. They also contain tobacco-derived substances but tobacco is not necessary for their operation. This allows the consumer to inhale a mixture of air and vapours from the device into the lungs (WHO, 2009).

Alternatively, waterpipes are a way of smoking tobacco, sometimes mixed with fruit or molasses sugar, through a bowl and hose or tube. Waterpipes can also be tobacco-based or come in ‘herbal’ forms. Although many consider this type of smoking safer, it carries many of the same toxins and health risks as cigarettes (CDC, 2015).

While nicotine causes the dependence on cigarettes, it is the tobacco which causes the majority of the damage to health (Sweanor, 2000).

Therefore, Z72.0 Tobacco use, current:

is assigned where use of waterpipes is documented, as they are a form of tobacco smoking is not assigned for use of electronic cigarettes, as these devices do not deliver tobacco.

The smoking of both e-cigarettes and waterpipes also qualify for assignment of codes from category F17 Mental and behavioural disorders due to use of tobacco (which includes use of nicotine) where supported in the documentation.

References:Centre for Disease Control and Prevention (CDC) 2015, Smoking & Tobacco use: Hookas, viewed 11 February 2016 http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/

Sweanor, D 2000, ‘Is it the nicotine or the tobacco?’, Bulletin of the World Health Organization, volume 78 no.7, viewed 12 February 2016 http://www.who.int/bulletin/archives/78(7)943.pdf

World Health Organization (WHO) 2009, WHO Technical Report Series 955, WHO Study Group on tobacco product regulation: a report on the scientific basis of tobacco product regulation: third report of a WHO study group, viewed 12 February 2016 http://apps.who.int/iris/bitstream/10665/44213/1/9789241209557_eng.pdf


Please note: The tobacco team are very interested in being able to capture E-cigarette use, therefore could you please add free text on the code descriptor for example, Z8643 Ex-smoker - currently using E-cigarette.

For more information about E-cigarettes please refer to the Ministry's website on the link belowhttp://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/advice-use-e-cigarettes


http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/advice-use-e-cigarettes

http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/advice-use-e-cigarettes


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SUBJECT: External cause of injury code for golf buggy (cart)

Q:What is the correct external cause of injury code to assign for a passenger falling from a golf buggy (cart)?

A:Golf buggies (carts) use specially designed tyres that can manoeuvre the different terrains of a golf course such as turf, bitumen, smooth paved surfaces, wooded areas, sand and mud and therefore meet the definition of a special all-terrain vehicle in the Tabular List/External Causes of Morbidity and Mortality/Accidents/Transport Accidents, under point (x) of Definitions Related to Transport which states:

A special all-terrain vehicle is a motor vehicle of special design to enable it to negotiaterough or soft terrain or snow…

The appropriate external cause of injury code to assign for a passenger falling from a golf buggy (cart) is V86.62 Passenger of all-terrain or other off-road motor vehicle injured in nontraffic accident, four-wheeled special all-terrain or other off-road motor vehicle, following the index pathway:

Accident - transport- - all-terrain or off-road vehicle (nontraffic)- - - passenger V86.6-

Improvements to the Alphabetic Index will be considered for a future edition.




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SUBJECT: Adjustment of gastric balloon

Q:What code is assigned for adjustment of a gastric balloon?

A:Adjustment of a gastric balloon is an endoscopic procedure, requiring the administration of sedation and preoperative preparation (liquid diet for a number of days prior and fasting the night before the procedure). The position of the gastric balloon is identified using the endoscope and saline is inserted (to further inflate) or aspirated (to partially deflate) the gastric balloon.While there are codes for insertion and removal of a gastric balloon in ACHI Ninth Edition, there is no code to classify adjustment of a gastric balloon.

Where adjustment of gastric balloon is performed, assign:90943-02 [889] Other endoscopic procedures for obesity

by following the index pathway:

Procedure- for- - obesity NEC- - - endoscopic 90943-02 [889]

Creation of a code for endoscopic adjustment of device in stomach will be considered for a future edition of ACHI.




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SUBJECT: Vasa praevia as the indication for elective caesarean section

Q:Is O69.4 Labour and delivery complicated by vasa praevia the correct code to assign when vasa praevia is documented as the indication for elective caesarean section and therefore there is no labour?

A:Vasa praevia occurs when the fetal/umbilical vessels cross the membranes of the lower uterine segment above the cervix (internal cervical os) and below the fetal presenting part. These vessels are unprotected and unsupported by the umbilical cord or placental tissue and are therefore at risk of rupturing at the time of membrane rupture, resulting in fetal haemorrhage.

Risk factors for vasa praevia include:

placenta praevia bilobed placenta/succenturiate lobe velamentous cord insertion IVF pregnancy Multiple pregnancy

Antenatal diagnosis of vasa praevia allows for elective caesarean section (prior to the onset of labour) to be performed, in order to avoid membrane rupture (spontaneous or artificial) with subsequent fetal haemorrhage.

If vasa praevia is undiagnosed antenatally, patients may present in labour with variable decelerations and palpable vessels with intact membranes, and/or intrapartum vaginal haemorrhage with acute fetal distress following rupture of membranes. This situation requires delivery by emergency caesarean section due to the significant risk to the fetus.

Vasa praevia is classified to O69.4 Labour and delivery complicated by vasa praevia

following the index entry:

Vasa praevia O69.4

As per ICD-10-AM Tabular List Conventions, the term and in the code title (O69.4 Labour and delivery complicated by vasa praevia) means and/or. Therefore O69.4 is the correct code to assign even when there is no labour. For example, vasa praevia is a complication of the delivery when it is documented as the indication for an elective caesarean section.

References:Mount Sinai Hospital, Sinai Health System 2016, Vasa previa viewed 2 February 2016, http://www.mountsinai.on.ca/care/placenta-clinic/complications/vasa-previaRoyal College of Obstetricians and Gynaecologists 2011, Placenta praevia, placenta praevia accrete and vasa praevia: diagnosis and management, RCOG Green-top Guideline No. 27viewed 2 February 2016, https://www.ranzcog.edu.au/doc/rcog-placenta-praevia-accreta.htmlThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2015, Vasa praevia, RANZCOG College Statement C-Obs 47, viewed 2 February 2016, https://www.ranzcog.edu.au/doc/vasa-praevia.html [PDF]




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SUBJECT: Ptosis of eyebrow

Q:What code should be assigned for ptosis of the eyebrow?

A:The index default at the lead term Ptosis is H02.4 Ptosis of eyelid and there is no subterm for ‘eyebrow’. This default is not correct for ‘ptosis of eyebrow’. Ptosis (also known as sagging) of the eyebrow is a condition separate to ptosis (or sagging) of the eyelid.

The correct ICD-10-AM code to assign for ptosis of the eyebrow is L98.7 Excessive and redundant skin and subcutaneous tissue (which has an inclusion term for sagging skin).

Follow the Alphabetic Index pathway:

Excess, excessive, excessively - skin (following weight loss) L98.7

Amendments to the Alphabetic Index will be considered for a future edition of ICD-10-AM.



NOT APPLICABLE TO NEW ZEALAND


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SUBJECT: Insertion, removal and exchange of silicone oil with repair of retinal detachment

Q:Should insertion, removal or exchange of silicone oil be coded separately when repair of retinal detachment is performed?

A:The insertion of silicone oil, variously described as fluid exchange or replacement of vitreous, is a component of most retinal detachment repair procedures, and therefore is not to be assigned a separate ACHI code as per ACS 0016 General procedure guidelines/procedure components.

Removal of the silicone oil is usually performed three to six months after retinal repair as an independent procedure and is classified to 42815-00 [205] Removal of silicone oil.

Ophthalmic intervention codes in ACHI are currently under review.




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SUBJECT: Chondroplasty of wrist

Q:What is the correct code to assign for chondroplasty of the wrist?

A:There is no specific code in ACHI for chondroplasty of the wrist, however ACHI classifies chondroplasty of other sites to blocks for ‘other repair procedures’.

Therefore assign 90542-00 [1468] Other repair of wrist following the index pathway:

Repair- wrist NEC 90542-00 [1468]

Where chondroplasty of the wrist is performed arthroscopically, also assign 49218-00 [1443] Arthroscopy of wrist, as per ACS 0023 Laparoscopic/arthroscopic/endoscopic surgery.

Amendments to ACHI Alphabetic Index will be considered for a future edition of ACHI.



coding rules - current as at 16-mar-2016 03:51

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