|
Query Number |
1892
|
Retired:
30/06/2010 |
|
Title |
ACS 940 and Acute Myocardial Infarction
|
|
Question |
ACS 0940 Ischaemic heart disease, section title Acute Myocardial Infarction (Classification) , pg 153. The 3rd paragraph of this section states “codes from category I21 should be assigned for an infarction in both the first hospital to which the patient is admitted for treatment and any other acute care facility to which the patient is transferred within 4 weeks (28 days) or less from onset of the infarction”. Coders are interpreting this standard differently. Some interpret this to mean if a patient is treated for their AMI, discharged home then re-admitted to another hospital (or the same one) a few days later, the AMI should be coded during the subsequent episode if it is less than 28 days since the AMI first occurred. Other coders are only assigning an AMI code during a subsequent episode of care if the patient is admitted for an initial episode of care for an AMI and subsequently transferred to another hospital within 28 days of the initial AMI (usually for treatment). Basically coders are placing emphasis on two different things:1) The 28 days or,2) The word “transferred”.Question: If a patient has an AMI, is treated, discharged home (within 5 days), referred to another hospital for PTCA and stent insertion and subsequently admitted to that hospital 10 days after discharge from the first hospital, should the AMI be coded by the hospital performing the PTCA and stent insertion? If the MI is coded, the episode groups to DRG F10Z Percutaneous Coronary Angioplasty with AMI, WIES = 2.3343. If the MI is not coded (and coronary artery disease is assigned as the principal diagnosis), the episode groups to DRG F15Z Percutaneous Coronary Angioplasty without AMI with Stent Insertion, WIES 1.871.Search Details: ACS 0940 Ischaemic Heart Disease pg 153
|
|
Response |
The NCCH has been consulted with regards to this complex query, and has responded in the following manner:
'Due to the complexity of this issue, the NCCH is withholding a decision on this query in order to seek advice from the Cardiovascular CCCG and CSAC. A task has been created to investigate this matter further.
A final decision will be added to the query database when available.'
In light of this, the Committee has decided to provide an interim response that can be followed until the NCCH is in the position to provide a definitive position. When the NCCH does provide a response to this query, the VICC will ensure to highlight this in the ICD Coding Newsletter to ensure that Victorian coders are aware of this. In the meantime, Victorian coders should adhere to the following advice.
For patients who have previously had an AMI who are admitted or transferred to your hospital, apply ACS 0001 'Principal Diagnosis' and ACS 0002 'Additional Diagnoses' to determine if the AMI should be coded.
Once you have determined that the AMI requires coding,
· If the patient is admitted (or transferred) to your hospital within 28 days of the AMI, use the code for a current AMI
· If the patient is admitted (or transferred) to your hospital more than 28 days following the AMI, use the code for an 'old' AMI
Each case will depend on the individual circumstances.
We acknowledge that ACS 0940 'Ischaemic heart disease Acute Myocardial Infarction' refers to 'transferred' patients, however we consider that this should also apply to patients separated from hospital and readmitted.
|
|
Publication Date |
2005-06 Fourth quarter
|
|
ICD 10 AM Edition |
Fourth edition
|
|
|
Query Number |
1894
|
Retired:
30/06/2010 |
|
Title |
ACS 1541 Elective and emergency caesarean
|
|
Question |
We are querying the intent of ACS 1541 Elective and Emergency Caesarean, particularly in relation to the mismatch of an anaesthetist’s definition of either elective or emergency via the use of ASA scores. If the anaesthetist documents ‘E’ for emergency, coders have no choice but to code emergency (anaesthetic) and are concerned when, on occasion, ‘elective and emergency’ do not match. For example, a patient with a history of two LUSCSs is booked to have an elective LUSCS on 19 February on the basis of current breech presentation and previous history. On 13 February she was admitted contracting with bulging membranes and couldn’t get a satisfactory CTG reading so the decision was made for a LUSCS. ‘Emergency LUSCS’ documented by anaesthetist ASA = 1E and ‘Emergency LUSCS’ documented by obstetrician. However, ACS 1541 Elective and Emergency Caesarean precludes the use of ‘emergency’ LUSCS and therefore we have to code
16520-02 [1340] Elective lower segment caesarean section
From a clinical risk management point of view, ACS 1541 makes it impossible to capture elective caesareans that become emergency. This high-risk group is therefore unable to be easily identified through our morbidity collection. We want to include emergency caesareans in our medical record screening program but retrieval by the emergency caesarean code doesn’t capture all the cases we feel need to be looked at. The difference in terminology becomes a problem in comparing statistics, as the Perinatal Data Collection Unit (PDCU) classifies booked caesareans that become emergency as ‘emergency’ whereas ours stay ‘elective’. Perhaps the time has come to identify these two groups with a fifth digit for ‘emergency caesarean’ and ‘emergency caesarean booked elective’ to align with PDCU etc.
|
|
Response |
The Committee believes that the definitions of emergency and elective Caesarean as defined by the PDCU are consistent with the definitions outlined in ACS 1541 Elective and Emergency Caesarean. It would seem that the inquirer has misinterpreted the PDCU definition of ‘elective caesarean - labour’, and should refer to ‘Births in Victoria 1999-2000’ published by the PDCU, Victoria 2001, for the current definitions.
If an anesthetist is assessing a patient in an emergency situation, the ASA modifier ‘E’ will indicate this. An anaesthetist is not concerned with whether the patient has a Caesarean planned for a future date. Therefore, it can be entirely appropriate to have ‘inconsistency’ in terms of the ASA ‘emergency’ indicator relating to an ‘elective’ Caesarean procedure code.
The collection of data for elective caesareans that become emergency caesareans is made difficult by this coding practice; however, both the ACS and the PDCU definitions support this practice.
|
|
Publication Date |
2002-03 May
|
|
ICD 10 AM Edition |
Third edition
|
|
|
Query Number |
1895
|
Retired:
30/06/2010 |
|
Title |
Activity code
|
|
Question |
Scenario 1:Male presented with shortness of breath and subsequent chest pain and was admitted with angina due to fighting fires in the bush. As there is no mention of his being either employed as a fire fighter or acting as a volunteer, what activity code should be used? Scenario 2:Female admitted with smoke inhalation while fighting fires as a volunteer. What activity code should be used?
|
|
Response |
When selecting an activity code to assign for fire fighting, a problem arises when the exact fire-fighting role of the patient is unknown. The patient may be employed as a firefighter, or be employed elsewhere and released for firefighting duty, or they may be a volunteer fire fighter.
Scenario 1: If it unknown whether or not the patient was employed, or was acting as a volunteer, then assign:
U73.8 Other specified activity
It may be helpful to check the account class of the patient, and if this indicates ‘workcover’, it could be presumed that the patient was a paid employee.
If the patient was fighting fires in a paid capacity, it would be correct to assign:
Activity U73.9
-work (for income) U73.09
--fire brigade services U73.08
U73.08 Other specified work for income
Scenario 2: If the patient was working as a volunteer fire fighter, and therefore not being paid for this role, it would be correct to assign:
U73.1 While engaged in other types of work
|
|
Publication Date |
2002-03 May
|
|
ICD 10 AM Edition |
Third edition
|
|
|
Query Number |
1896
|
Retired:
30/06/2010 |
|
Title |
Diabetic with ARF and high BSLs due to Prednisolone
|
|
Question |
Type 2 diabetic admitted in acute renal failure (ARF) and high blood sugar levels (BSLs) due to Prednisolone. Patient stated as ‘not unstable diabetes’.Question 1:There is another specified cause of the ARF, i.e. drug use, therefore, the ARF should not be attributed to diabetes, but the example in ACS 0401 Diabetes, acute renal failure, states to link them anyway. This seems to go against how we usually code adverse effects, but is the argument that this is different because this involves diabetes (and everything about diabetes is different!).Is the coding of ARF due to drug in ACS 0401 Diabetes correct?Question 2:How do we code high BSLs due to a drug in a diabetic patient?Index – Hyperglycaemia, due to diabetes – see Diabetes, by type.Patient did not have unstable diabetes.Do we use R73 Elevated blood glucose level?
ACS 0401 Diabetes, p 97.
Acute renal failure
Acute renal failure in diabetes (which may be reversible) can be precipitated by illness including those causing dehydration and by the use of concentrated solutions of intravenous radiological contrast media, particularly where the patient has been fluid restricted. This may be more likely to occur when diabetic nephropathy is already present.
When acute renal failure develops in diabetes under these circumstances, code as follows:
E1-.29 Diabetes with other specified renal complication
N17.9 Acute renal failure, unspecified
Y57.5 X-ray contrast media causing adverse effects in therapeutic use
Appropriate place of occurrence code (Y92.-)
|
|
Response |
The NCCH was asked to clarify the correct approach when coding conditions attributable to causes other than diabetes, with reference to this particular query. The NCCH provided the following responses to the specific questions raised in this query:
1. ACS 0401 Diabetes mellitus and impaired glucose regulation states that acute renal failure (ARF) in diabetes can be precipitated by illness and by the use of concentrated intravenous solutions. Therefore, for the scenario cited, it would be appropriate to follow the classification advice given in the ACS. The ‘in’ (diabetes) is not a cause and effect relationship, but rather a combination of conditions. A non diabetic person would not be as susceptible to developing ARF in the circumstances described, thus the need to capture the patient's diabetic status.
2. Code high blood sugar levels as directed by the index:
Hyperglycaemia
-with diabetes (mellitus) see Diabetes, by type
Note that the index uses the terms ‘with diabetes’ not ‘due to’.
Therefore, for the case cited, assign the following codes:
E11.29 Type 2 diabetes mellitus with other specified renal complication
N17.9 Acute renal failure, unspecified
Y42.0 Glucocorticoids and synthetic analogues (Adverse effect in therapeutic use) with appropriate place of occurrence code
The Committee accepts this advice from the NCCH, and acknowledges that this may be a change in coding practice for some coders, as there has been advice published previously in the Victorian Coding Newsletter, November 2000, Diabetes Quiz Answers, which is overruled by this more recent advice.
|
|
Publication Date |
2003-04 May
|
|
ICD 10 AM Edition |
Third edition
|
|
|
Query Number |
1897
|
Retired:
30/06/2010 |
|
Title |
Place of occurrence for adverse effect of drug
|
|
Question |
There have been many discussions at our hospital about what place of occurrence (POO) code should be assigned for a patient being admitted with an adverse effect of a prescribed drug. Could you please advise the correct answer?Example:Patient admitted with severe rash due to antibiotics, prescribed by LMO.The POO code is used to identify the place where the injury or poisoning (external cause) took place, which is usually unknown unless it occurred during an inpatient episode. However, many coders are arguing that
Y92.22 Health service area
should be assigned because it was a prescribed drug. Isn’t it where the poisoning/accident occurred, not where the drugs were dispensed?The references I found were Volume 1, page 503, and Coding Matters Vol 7, No. 4, pg 13. The coders arguing for ‘Y92.22 Health service area’ seem to think there has been something else published but I can’t find anything.
|
|
Response |
As outlined in Coding Matters Vol 7 No.4 p13, the POO code relates to the external cause, or the agent that caused the problem, not the adverse effect of that agent. In the case of an adverse effect of a prescribed drug, the external cause is the drug, and the POO code relates to the place that the drug treatment was initiated.
Therefore, any adverse effect from a prescribed drug, which can be assumed to be dispensed from a health service area of some description, should be coded to:
Y92.22 Health service area
|
|
Publication Date |
2002-03 May
|
|
ICD 10 AM Edition |
Third edition
|
|
