Coding Rule is effective for event records with an event end date on or after 1 January 2017



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Australian Consortium for Classification Development

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Coding Rule is effective for event records with an event end date on or after 1 January 2017

Ref No: Q3023 | Published On: 15-Dec-2016 | Status: Current

SUBJECT:  Respiratory Distress, unspecified

NOTE: this may be a change in coding practice

Q:

Does the statement in ACS 1614 Respiratory distress syndrome/hyaline membrane disease/surfactant deficiency regarding unspecified respiratory distress mean that P22.9 Respiratory distress of newborn, unspecified should never be assigned?



A:

Respiratory distress in newborns may have many causes including transient tachypnoea of the newborn, respiratory distress syndrome (RSD)/hyaline membrane disease, meconium aspiration syndrome, infections or underlying congenital heart defects.

ACS 1614 Respiratory distress syndrome/hyaline membrane disease/surfactant deficiency states:

The term 'respiratory distress unspecified' should not be coded as such, as it is considered a symptom not a diagnosis. Further information regarding a definitive diagnosis should be sought from the clinician.

That is, where documentation or clinical advice is available to identify the cause of the symptom ‘respiratory distress’, assign a code for the underlying cause (see examples above). Where there is no confirmation of an underlying cause, assign P22.9 Respiratory distress of newborn, unspecified as a last resort by following the Alphabetic Index:



Distress

- respiratory

- - newborn P22.9

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3068 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Drainage of parapharyngeal abscess

Q:

What is the correct code to assign for drainage of parapharyngeal abscess?



A:

In the absence of a specific code or index entries for drainage of parapharyngeal abscess, clinical advice supports the assignment of either of the following codes (as appropriate) as a best fit:

31409-00 [421] Excision of parapharyngeal lesion by cervical approach

31412-00 [421] Excision of recurrent or persistent parapharyngeal lesion by cervical approach

Amendments to ACHI will be considered for a future edition. 

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3069 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Stretta procedure

Q:

What code is assigned for Stretta procedure?



A:


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

Refer to Coding Rule HALO ablation therapy

Stretta procedure is performed for the treatment of gastro-oesophageal reflux disease (GORD). It involves radiofrequency (thermal) ablation of the lower oesophageal sphincter (LOS) and gastric cardia, via endoscopy. The thermal energy creates a lesion in the oesophagus, causing the treated area to swell and stiffen as it heals, resulting in an increased thickening of the LOS. The altered LOS, when closed, prevents stomach acid and contents from flowing back up to the oesophagus, thus eliminating GORD symptoms.

Assign 30478-22 [856] Endoscopic destruction of lesion or tissue of oesophagus for Stretta procedure by following the Alphabetic Index:



Oesophagoscopy

- with


- - radiofrequency (Halo) ablation 30478-22 [856]

Amendments to ICD-10-AM ACHI will be considered for a future edition.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3071 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Retinal artery occlusion

Q:

What is the correct code to assign for retinal artery occlusion?



A:


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

Retinal artery occlusion occurs when a blood clot or fat deposits block the artery. The majority of retinal artery occlusions are caused by platelet fibrin thrombi and emboli as a result of atherosclerotic disease. It is also seen with conditions such as emboli from valvular heart diseases, diabetes mellitus, hypertension, atrial fibrillation and temporal arteritis. It is more likely to occur if there is atherosclerosis of the arteries in the eye.

ACS 0941 Arterial disease/point 7 Occlusion states:

“The term 'occlusion' is used to describe complete blockage or obstruction of a vessel, usually due to atherosclerosis. Occlusion of arteries that is not documented as due to another cause should be assigned the appropriate atherosclerosis code.”

Therefore, if retinal artery occlusion is documented and the underlying cause is unknown or not specified, assign I70.8 Atherosclerosis of other arteries following the Alphabetic index:



Atherosclerosis — see Arteriosclerosis

Arteriosclerosis, arteriosclerotic I70.9

- retina (vascular) I70.8

If the underlying cause of retinal artery occlusion is specified as a condition other than atherosclerosis, assign an appropriate code from H34 Retinal vascular occlusions with an additional code for the underlying cause.

Amendments to the classification will be considered for a future edition.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3072 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Basilar artery coiling

Q:

What is the correct code assignment for coiling / stenting of basilar artery aneurysms?



A:

The basilar artery is a precerebral artery, which is an artery leading to the cerebrum, but not within the cerebrum.

A basilar artery aneurysm is classified in ICD-10-AM to I72.5 Aneurysm and dissection of other precerebral arteries following the Alphabetic Index:

Aneurysm (anastomotic) (artery) (cirsoid) (diffuse) (false) (fusiform) (micro) (multiple) (saccular)

- basilar (trunk) I72.5

Coiling of a basilar artery aneurysm is classified in ACHI to 35321-03 [768] Transcatheter embolisation of blood vessels, face and neck (as a best fit) following the ACHI Alphabetic Index:

Coiling

- aneurysm — see Administration/agent/occlude/blood vessel, transcatheter/by site



Administration

- agent (to)

- - occlude (embolise)

- - - blood vessel, transcatheter NEC

- - - - neck 35321-03 [768]



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3073 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Sameday admissions for chemotherapy/pharmacotherapy for neoplasm(s) and neoplasm related conditions

Q:

What are the correct codes to assign for same-day admissions for administration of Neulasta, IV hydration or other prophylactic pharmacotherapy?



A:

Neulasta is a drug used to treat or prevent neutropenia in patients with neoplasms or undergoing chemotherapy. It is administered subcutaneously and must be administered 24 hours post chemotherapy to avoid interaction.

Same-day episode of care for administration of intravenous (IV) hydration is also a common pharmacotherapy protocol to treat or prevent dehydration and/or kidney function disorders in patients undergoing pharmacotherapy, as these are common neoplasm/chemotherapy related conditions.

ACS 0044 Chemotherapy states:



For coding purposes, chemotherapy is defined as: “The administration of any therapeutic substance (usually a drug), excluding blood and blood products.”

Therefore, for a same-day episode of care for administration of Neulasta, IV hydration or other prophylactic pharmacotherapy (which meets the definition of chemotherapy as stated above) for a patient with a neoplasm or neoplasm related condition, assign:



    1. Z51.1 Pharmacotherapy session for neoplasm as principal diagnosis

    2. a code for the neoplasm being treated as the first additional diagnosis (see also ACS 0236 Neoplasm coding and sequencing)

    3. additional diagnosis code(s) for any documented neoplasm related condition(s) being treated

    4. the appropriate ACHI code, for example:

    1. 96200-00 [1920] Subcutaneous administration of pharmacological agent, antineoplastic agent for administration of Neulasta

    2. 96199-00 [1920] Intravenous administration of pharmacological agent, antineoplastic agent for administration of IV hydration

Note: As per Example 2 in ACS 0044 Chemotherapy and the instructional note at block [1920] Administration of pharmacotherapy, the extension -00 Antineoplastic agent is assigned for agents used in the treatment of neoplasms and/or neoplasm related conditions.

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3074 | Published On: 15-Dec-2016 | Status: Current

SUBJECT:  External cause of injury code for tattoo complication

NOTE: this may be a change in coding practice

Q:

Which external cause of injury code should be assigned for a tattoo needle complication?



A:

Tattoos are a permanent or non-permanent mark or design made on skin. Typically, for permanent decorative tattoos, a powered hand tool is used to create a tattoo, with one or more needles piercing the skin repeatedly to insert coloured ink droplets into the dermis via the puncture sites.

The health risks associated with tattoos include allergic reactions to the tattoo dyes causing itch, dermatitis, acute inflammatory reactions, skin infections, keloid scars, granulomas, and blood borne diseases (eg hepatitis B and hepatitis C).

Where documentation clearly indicates that a condition has been caused by direct contact with a tattoo needle (for example, infection due to a contaminated tattoo needle), assign a code for the manifestation (eg the skin infection) with W29.8 Contact with other specified powered hand tools and household machinery by following the External Causes of Injury Alphabetic Index:



Contact (accidental)

- with


- - tool

- - - powered

- - - - specified NEC W29.8

Improvements to ICD-10-AM will be considered for a future edition.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3085 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Removal of prosthetic arteriovenous access device

Q:

How do you code removal of prosthetic arteriovenous access device?



A:

Arteriovenous (vascular) access is created for patients requiring haemodialysis. There are three types of arteriovenous access:



    1. Arteriovenous fistula – the surgical joining of an artery to a vein

    1. Arteriovenous graft – insertion of a (synthetic) prosthetic device or biograft (eg xenograft (heterograft) or allograft (homograft)). The biograft or synthetic tube is inserted under the skin and is attached at one end to an artery, and at the other end to a vein

    1.  External catheter (shunt) – insertion of a catheter to provide temporary vascular access.

In ACHI, the terminology used, and classification of arteriovenous fistula and graft are overlapping.

For removal of prosthetic arteriovenous access device, assign:

34130-00 [765] Closure of surgically created arteriovenous fistula of limb

by following the Alphabetic Index:



Removal

- arteriovenous fistula

- - surgically created 34130-00 [765]
Amendments to ACHI will be considered for a future edition.

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3088 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Sclerotherapy for varicose vein(s)

Q:

What is the correct code to assign when a single varicose vein is injected with sclerosing agent?




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

A:

ACHI Alphabetic Index does not contain a specific entry for injection of sclerosing agent or sclerotherapy into a single varicose vein. Injection of sclerosing agent (sclerotherapy) into varicose veins is an Inclusion term at 32500-01 [722] Multiple injections of varicose veins. ACHI references to disease conditions in multiple terms are applicable to single and vice versa (for example, varicose veins are interpreted as either varicose veins or varicose vein).

Therefore, assign 32500-01 [722] Multiple injections of varicose veins for injection of sclerosing agent into a single varicose vein, as a best fit.

Amendments to ACHI will be considered for a future edition.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3093 | Published On: 15-Dec-2016 | Status: Current

SUBJECT:  TransPyloric Shuttle insertion

Q:


What procedure code is assigned for TransPyloric Shuttle insertion?

A:


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

The TransPyloric Shuttle (TPS®) is a device used to treat obesity. The device is inserted endoscopically into the stomach and consists of a large spherical bulb connected by a silicone tether that passes through the pylorus to a smaller cylindrical bulb in the duodenum. The large bulb prevents the device from migrating out of the stomach, and intermittently creates a seal at the pylorus to delay partially digested food and gastric juices from flowing into the duodenum. This device causes the stomach to fill up faster, and prolongs appetite satiety which reduces the overall calorie intake resulting in weight loss.

Assign 90950-02 [889] Endoscopic insertion of device into stomach for the endoscopic insertion of a TransPyloric Shuttle for the treatment of obesity by following the Alphabetic Index:



Insertion

- device

- - stomach, for obesity (endoscopic) (see also Banding/gastric, for obesity) 90950-02 [889]

Amendments to ACHI will be considered for a future edition.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3097 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Laminectomy

Q:

What is the appropriate code to assign for documentation of laminectomy without further specificity?



A:

A laminectomy is a surgical excision of the angled segments of bone (laminae) of the vertebra to gain access to the structures associated with the spinal cord. A laminectomy is performed to reduce pressure on the spinal nerve roots or the spinal cord, but may also provide access (ie the operative approach) for removal of intervertebral discs (discectomy) or spinal lesions/tumours.

Where there is documentation of ‘laminectomy’ without any further specificity, clinical consultation should be sought to clarify the purpose of the laminectomy ie for ‘decompression’ and/or any other procedures performed.

If, after clinical consultation (or if consultation is not possible), ‘laminectomy’ was not associated with other procedures or clarified further, follow the Alphabetic Index: 

 Laminectomy

- decompressive — see Decompression/spinal



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3110 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Single delivery assisted by forceps and McRoberts manoeuvre

Q:

How do you code a single delivery where forceps and McRoberts manoeuvre are used to assist the delivery? For example, forceps delivery of head followed by delivery of shoulder and arm via McRoberts manoeuvre.



A:

The following is of note when selecting an appropriate code from O80-O84 Delivery:



    1. Each of the above categories are mutually exclusive and hierarchical

    2. O80 Single spontaneous delivery is never assigned if a delivery assistance procedure has been performed

    3. O81 Single delivery by forceps and vacuum extractor is assigned if delivery is assisted using forceps or vacuum extractor. The exception is where forceps are used to rotate the fetal head only, but delivery is not completed using forceps

    4. O82 Single delivery by caesarean section is assigned if delivery is completed by caesarean section, regardless of whether forceps or a vacuum extraction has been attempted, or any other assistance procedure has been performed

    5. O83 Other assisted single delivery is assigned if delivery is assisted by any method other than by forceps or vacuum extractor (assign O81) or caesarean section (assign O82). This includes where forceps are used to rotate the fetal head, but delivery is not completed using forceps.

In the cited scenario (forceps delivery of head followed by delivery of shoulder and arm via McRoberts manoeuvre) the delivery was assisted using forceps.

Assign O81 Single delivery by forceps and vacuum extractor by following the ICD-10-AM Alphabetic Index:



Delivery

- assisted

- - by

- - - forceps or vacuum extractor O81



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3112 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Non accidental injury

Q:

Can an injury documented as ‘non accidental’ be classified as assault?



A:

In Chapter 20 External causes of morbidity and mortality, the category for Assault (X85–Y09) includes injuries inflicted by another person with the intent to injure or kill, by any means.

The General arrangement of the Alphabetic Index of Diseases states that Section II (External causes of injury):


    1. priority modifiers include transport accidents, complications of medical and surgical procedures, intentional self-harm, assault, legal intervention, or war operations

    2. key words are 'Complication' (for medical and surgical procedures), 'Sequelae', 'Suicide', 'Assault', 'Legal intervention' and 'War operations':Users should remember the presence of these special lists whenever they have difficulty locating index entries for the relevant conditions, problems or circumstances; by scrutinizing the indented terms, guidance can be found as to the code numbers of all the relevant categories even if not reported in precisely the same words.

The term ‘non-accidental’ indicates purposeful intent. Therefore, a non-accidental injury inflicted by one person on another, is classified in ICD-10 and ICD-10-AM as assault (see also the Instructional notes at X85-Y09).

This is supported by the External causes of injury Alphabetic Index:



Injury, injured (accidental(ly)) NEC X59

 - purposely (inflicted) by other person(s) (see also Assault) Y09.0-



Assault (by) (homicidal) (in) Y09.0-

The lead term Assault lists a number of subterms for mechanisms of injury (ie the cause of the injury, for example bite, fire, pushing). Where a non-accidental injury is inflicted by another person (ie an assault is perpetrated), assign:



    1. a code for the injury (S00-T98 – see Alphabetic Index)

    2. an external cause code for assault (see External causes of injury Alphabetic Index: Assault)

    3. Y92.- Place of occurrence

    4. U50-U73 Activity

Amendments to ICD-10-AM will be considered for a future edition.

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3115 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Deactivation of AICD for moribund patient

Q:

How do you code deactivation of an AICD (automatic implantable cardiac defibrillator) for a patient who is near the end of life?



A:

Deactivation of an AICD (automatic implantable cardiac defibrillator) is a non-invasive procedure performed when a patient is near the end of life. The purpose of the deactivation is to prevent the AICD activating due to the expected alteration in the patient’s cardiac rhythm.

Assign Z45.0 Adjustment and management of cardiac device as an additional diagnosis to the documented principal diagnosis.

As per ACS 0042 Procedures normally not coded, the resources used to perform the deactivation are reflected in Z45.0. Therefore, it is not necessary to assign an ACHI code (eg adjustment of cardiac defibrillator generator) for deactivation of the AICD.

Amendments to ICD-10-AM/ACHI/ACS will be considered for a future edition.

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3117 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Repair of diastasis recti

Q:

What ACHI code is assigned for repair of diastasis recti (recti divarication)?



A:

The rectus abdominis muscle is part of the musculoaponeurotic layer of the anterior abdominal wall. Diastasis recti (also known as rectus abdominis diastasis or recti divarication) are separation of the two rectus muscles. In severe cases, surgical closure of the separated muscles may be required.

Assign 45570-00 [1000] Closure of abdomen with repair of musculoaponeurotic layer for repair of diastasis recti (recti divarication) by following the Alphabetic Index:

Repair

- abdominal wall

- - musculoaponeurotic layer 45570-00 [1000]
Note: Assignment of the above ACHI code with principal diagnosis M62.08 Diastasis of muscle, other will result in assignment of DRG 801C OR Procedures Unrelated to Principal Diagnosis, Minor Complexity in version 9 of the grouper. ACCD will consider this issue in a future version of the AR-DRG classification

Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3118 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Removal of a bone anchored hearing aid (BAHA) implant

Q:

What is the correct ACHI code to assign for the removal of BAHA titanium implants?



A:

The removal of bone anchored hearing aids (BAHA) is usually performed due to skin reactions, for example flap necrosis, granulation or hyperplasia of skin around the implant site, or infection.

Assign 92202-00 [1908] Removal of therapeutic device, not elsewhere classified as a best fit, by following the Alphabetic Index:

Removal — see also Excision

- device

- - therapeutic NEC 92202-00 [1908]

A review of the classification of BAHA will be considered for a future edition of ACHI.



Published 15 December 2016,
for implementation 01 January 2017.

Ref No: Q3120 | Published On: 15-Dec-2016 | Status: Current

SUBJECT: Insufficiency fracture

Q:

How should insufficiency fractures be classified?



A:

An insufficiency fracture is a type of pathological or stress fracture that occurs as a result of normal physiological stress on abnormal bone. These fractures are seen in patients with conditions such as osteoporosis, rheumatoid arthritis, Paget’s disease, osteomalacia, diabetes, and sometimes as a result of radiotherapy. These fractures are usually located in the vertebra, tibia or fibula or the calcaneus in the foot.

Assign an appropriate code from the Alphabetic Index at:

Fracture


- pathological (cause unknown) M84.4-

- - with osteoporosis M80.9-

- - - disuse M80.2-

- - - drug-induced M80.4-

- - - idiopathic M80.5-

- - - postmenopausal M80.0-

- - - postoophorectomy M80.1-

- - - postprocedural malabsorption M80.3-

- - - specified NEC M80.8-

- - due to neoplastic disease NEC (M8000/1) (see also Neoplasm) D48.9† M90.7-*

For insufficiency fractures in a patient with osteoporosis NOS, assign M80.9- Unspecified osteoporosis with pathological fracture. Where the type of osteoporosis is known, assign a code from one of the options at Fracture/pathological/with osteoporosis (see above).

Amendments will be considered for a future edition of ICD-10-AM.



Published 15 December 2016,
for implementation 01 January 2017.

Coding Rules - Current as at 15-Dec-2016 11:48

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