ICD Coding Newsletter June 2001 Distribution List

Transcription

ICD Coding Newsletter
(incorporating Special Edition features)
June 2001
Distribution List
Health Information Manager/s (HIMS)
Clinical Coders
Information Technology (IT)
Interested Others
.....................................................................................
.....................................................................................
.....................................................................................
The ICD Coding Newsletter supports the clinical coding function performed in Victoria
by Health Information Managers and Clinical Coders, by providing relevant information
for these professionals and their associates.
The newsletter, prepared by the Victorian ICD Coding Committee in conjunction with the
Department of Human Services, seeks to:
•
Ensure the standardisation of coding practice across the state
•
Provide a forum for resolution of coding queries
•
Address topical coding education issues
•
Inform on national and state coding issues from the Victorian perspective.
The scope of the newsletter includes coding feature articles, selected coding queries and
responses, and various information updates including feedback on the quality and uses
of coded data (as reported to the Victorian Admitted Episodes Dataset).
Should you have any queries or comments regarding the ICD Coding Newsletter, contact
Nicolette Thein:
Telephone
9616 8141
Fax
9616 7629
Email
[email protected]
Website
www.dhs.vic.gov.au/ahs/hdss
Notification of change of address or requests regarding the mailing list may be directed to any of
the above contacts.
An electronic coding query form can be completed at:
www.dhs.vic.gov.au/ahs/hdss/icdquery.htm
May be reproduced
ICD Coding Newsletter – June 2001
i
Contents
Coding Features...................................................................................................... 1
Additional Diagnoses – Queries and Responses ................................................................... 1
Minor Trauma Coding............................................................................................................... 4
ACS 0031 Anaesthesia ............................................................................................................... 7
HIMAA Education Seminar................................................................................. 9
List of Selected ICD-10-AM Coding Queries................................................. 10
Coding Corkboard ............................................................................................... 37
Coding Newsletter Mailing List............................................................................................. 37
Health Funds and Australian Coding Standards ................................................................ 38
Websites..................................................................................................................................... 39
Information Updates ........................................................................................... 40
Data Quality .............................................................................................................................. 40
Audits of VAED Data .......................................................................................................... 40
A review of Newborns – Qualified but no condition coded .......................................... 42
Dual Coding Study Results................................................................................................. 47
Reporting To The VAED ......................................................................................................... 49
AR-DRG Modifications (2001-2002)................................................................................... 49
VAED Schedule Requirements 2001–2002........................................................................ 52
ICD-10-AM Library File for use in Victoria – 1.7.2001 .................................................... 56
NCCH Language of Health conference 2001 ........................................................................... 60
Coding Standards Advisory Committee............................................................................... 61
Coding Calendar of Events ................................................................................ 63
Victorian ICD Coding Committee.................................................................... 64
Member Profile – Evelyn Robinson ....................................................................................... 64
Members as at 1 June 2001 ...................................................................................................... 66
Next Meetings........................................................................................................................... 66
On a Lighter Note ................................................................................................ 67
Alphabetic Index to Victorian ICD-10-AM Coding Advice: July 1999 –
June 2001 ................................................................................................................ 68
Abbreviations ....................................................................................................... 79
May be reproduced
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Coding Features
Additional Diagnoses – Queries and Responses
The following three queries were omitted from publication in the previous
Newsletter awaiting finalisation by the Victorian Coding Committee. A complete list
of queries answered via the DHS ‘Additional Diagnoses Help Desk’ facility can also
be accessed at: www.dhs.vic.gov.au/ahs/hdss/clincode.htm
Query 10 - Neonates
There are often conditions documented on the Newborn Examination record, such as
birth traumas, including cephalhaematomas due to vacuum extraction or injuries
from forcep blades, birthmarks; and other abnormalities such as talipes, large for
dates, etc.
If these are observations alone, that is no specific care is instituted, should they be
coded?
Answer
Additional
Assign Code
Condition
(Yes/No)
Conditions
Yes
Reason for assigning/not assigning code
The Additional Diagnosis standard does not
documented on the
deal very well with conditions noted on the
Newborn
Newborn Examination record, and similar
Examination
documents in newborn records.
record, such as
birth trauma,
However, it is the opinion of the Victorian
birthmarks, other
ICD Coding Committee that neonatal
abnormalities.
conditions, such as congenital anomalies and
effects of birth trauma, are all actively
evaluated during the birth episode, and that
they should therefore be coded.
This instruction applies to the birth episode
only (for newborns admitted at birth or
during the mother’s delivery episode of care).
May be reproduced
1
Query 13 – Histology Findings
Patient admitted for total abdominal hysterectomy and bilateral salpingooophorectomy for endometrial hyperplasia due to Tamoxifen. Histology shows:
endometrial hyperplasia, small endometrial leiomyomata, low grade chronic
endometritis, atrophic ovaries, focal mild adenofibromatous change on surface of left
ovary.
Obviously the endometrial hyperplasia will be coded. Should the other findings be
coded?
Answer
Additional Condition
Assign Code
(Yes/No)
Endometrial
Yes
hyperplasia
As the patient is admitted for treatment of
endometrial hyperplasia, this finding
supports the admission diagnosis and would
be coded as principal diagnosis
Other findings on
Yes
histology.
•
Even though ACS 0010, Abnormal findings,
indicates that these conditions should not be
Small
coded unless their significance is indicated by
endometrial
the treating doctor and they meet ACS 0002,
leiomyomata
it is the opinion of the Victorian ICD Coding
Committee that the conditions noted on
•
Low grade
histology should be coded.
chronic
endometritis
Histology results are not well dealt with by
ACS 0010 as they usually provide definitive
•
Atrophic
information that does not require clinical
ovaries
interpretation (although they may require
clinical evaluation). That is, these conditions
•
Focal mild
either exist or they don’t, as opposed to a
adenofibroma-
microbiology finding of an organism that
tous change on
may or may not be indicative of an infection.
surface of left
ovary
Although this example is quite specific, it is
more common for patients to present with a
general symptom, and in these cases all the
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ICD Coding Newsletter - June 2001
May be reproduced
findings may be contributory factors in the
patient’s condition and would all be actively
evaluated in respect to the patients final
diagnosis (this evaluation may occur on
review of the histopathology during or after
the patient’s admission).
In this particular example, although the
reason for admission is the endometrial
hyperplasia and this is supported by the
histology result, it is felt that the other
conditions would be actively evaluated in the
context of the patient’s admission and
determination of the final diagnosis.
The Department of Human Services, via the
Victorian ICD Committee will work with the
NCCH to get clarification of ACS 0010.
Query 16 - Obstetrics
In relation to obstetric cases and the associated conditions standard do we code
placental abnormalities? For example, placental infarct.
Answer
Additional
Assign Code
Condition
(Yes/No)
Placental anomalies
Yes
•
The Additional Diagnosis standard does not
placental
deal very well with conditions noted on the
infarct
delivery summary form, and similar
•
knot in cord
documents in obstetric records.
•
true knot
However, it is the opinion of the Victorian
ICD Coding Committee that these conditions
are ‘actively evaluated’ during this episode of
care, and that they should therefore be coded.
May be reproduced
3
Minor Trauma Coding
Kylie Holcombe, St Vincent’s Hospital
These notes have been compiled to assist with the coding of minor trauma, for which there are
no actual documented injuries. It was identified in the 1999–2000 round of the VAED audit
that there were some problems in coding these types of cases and that the correction of coding
often resulted in a DRG change.
When a patient presents to Accident and Emergency due to trauma and there are no
physical signs of injury such as lacerations, contusions or fractures, the patient may
still have signs of having suffered an injury, such as presence of pain at the injured
site.
Coders should apply the following guidelines:
a)
Where pain is documented as due to an external cause but no specific injury
is documented, code as injury NOS of the site and the External Cause.
b)
Where a patient presents with pain but no external cause relationship is
documented, code the pain only. Do not code an external cause code, as it is
not related to the pain.
It is also very important to remember in what way codes may be used for research
and statistical purposes. If a clinician wished to do research on chest trauma it
would make sense to pull out all the cases that have an injury code relating to the
chest, but not necessarily to look at chest pain cases as well.
Many statistics are also drawn from the codes that are assigned - pain codes would
not interest those conducting research on injury or trauma; however, even an
unspecified injury code would enable more accurate injury and trauma statistics.
The following scenarios have been provided to assist assignment of appropriate
codes for minor trauma admissions.
4
May be reproduced
SCENARIO 1
A ninety year old patient is sent into hospital from her nursing home having fallen
onto her left side from her bed whilst resting. The patient is complaining of severe
pain in her left hip and is unable to weight bear on this leg. The hip is x-rayed and
no fracture is detected. The patient also has a small graze on her left elbow that is
cleaned and dressed. The patient is returned to the nursing home later in the
afternoon.
This patient’s main problem is the fact that she cannot weight bear, and the hip pain.
From the notes provided it is clear that the patient has suffered a trauma. It would
not make sense to code hip pain as M25.55 indicates a chronic or spontaneous hip
pain. To capture the correct ‘picture’ of this patient’s trauma, it should be coded as
follows:
S79.9
Unspecified injury of hip and thigh
S50.81
Abrasion of forearm
W06
Fall involving bed
(Injury, - hip)
Y92.22 Health service area
Y93.4
While resting, sleeping, eating or engaging in other vital activities
SCENARIO 2
A twenty year old man, who is the driver in a motor vehicle accident involving a
collision with a bus, is brought into Accident and Emergency complaining of chest
pain. The chest is tender on palpation where he hit the steering wheel, but the
patient is having no difficulty breathing and his chest x-ray reveals that no ribs have
been fractured. The man is given Panadol for the pain and sent home.
As in Scenario One, the patient has pain at the site of impact and therefore has
suffered an injury. If chest pain is coded, it would give the impression of a
spontaneous or chronic problem. Although additional external cause codes would
indicate the cause of the pain, the patient has suffered a trauma which should be
reflected in the coding:
S29.9 Unspecified injury of thorax
V44.5 Driver injured in collision with heavy transport vehicle or bus
Y92.4 Street and highway
Y93.9 Unspecified activity
May be reproduced
5
SCENARIO 3
An eighteen year old female who was a passenger in a two-car collision is brought
into Accident and Emergency. She is visibly distressed but is conscious and not
complaining of any pain or injury. Examination reveals no injuries.
In this scenario the patient is experiencing no pain and has no other injury. Whilst
this case would probably not meet the criteria for admission, if the admission were
clinically justified, it would be coded as:
Z04.1 Examination and observation following transport accident
V43.6 Passenger injured in collision with car, pick-up truck or van
Y92.4 Street and highway
Y93.9 Unspecified activity
SCENARIO 4
A fifty-five year old male presents to Accident and Emergency with a severe
headache. The patient claims that one week ago he fell off a ladder and struck his
head on a post. The patient has an old contusion on his scalp but a brain CT reveals
no internal injury. The patient is given pain relief and three hours later states he had
no headache at all. He is discharged home.
In this scenario there is no evidence that the headache is related to the injury
incurred one week before. If the headache had been present since the injury this may
be different, but would need to be clarified with the treating clinician. In this
instance the headache would be coded, but not the trauma, as follows:
R51
Headache
56001-00 [1952]
CT brain without contrast
6
May be reproduced
SCENARIO 5
A twenty-two year old male presents with a painful ankle four days after twisting
the ankle in a basketball game. Examination and x-ray reveal no apparent damage.
The clinician documents ankle pain secondary to basketball injury.
In this scenario the clinician has related the ankle pain to the trauma, therefore it
should be coded as a traumatic injury. It has not been specified as a sprain so it
should be coded as an ankle injury NOS:
S99.9 Unspecified injury of ankle and foot
X50
Overexertion and strenuous or repetitive movements
Y92.3 Sports and athletics area
Y93.05 Basketball
The assignment of codes should always tell the story. When you have finished
coding a trauma case, look at the codes and determine if you can tell what happened
to the patient by the codes alone. As per the Clinical Coders’ Creed you will ‘..need
to make decisions which are based on (your) experience and common sense’.
ACS 0031 Anaesthesia
Anaesthetic Procedure Codes
The NCCH intends to include a simplified range of anaesthetic procedure codes in
the Third Edition of ICD-10-AM. It is recognised that unwarranted time has been
spent by coders searching for specific anaesthetic information and that coders have
gone to great lengths to comply with ACS 0031. The Department of Human Services
recommends that the default codes from ACS 0031 Anaesthesia be used for the coding
of all anaesthetics for 2001-2002 separations, in preparation for the reduced range of
anaesthetic codes that will be available in the Third Edition. This means coders only
need to identify the type of anaesthetic (e.g. GA, epidural, caudal, spinal or sedation),
rather than search for detail of drugs or gases used, for episodes from 1 July 2001
Please refer to June 2001 Coding Matters for background information to these
forthcoming changes.
May be reproduced
7
Therefore, the following default codes are to be used:
General anaesthesia combined with major regional anaesthesia (epidural, caudal or
spinal)
92502-03 [1910]
General anaesthesia combined with major regional anaesthesia
General anaesthesia
92502-02 [1910]
Intravenous and inhalational general anaesthesia
Major regional
18209-05 [32]
Epidural injection of local anaesthetic, combined preoperative,
intraoperative and postoperative
18209-02 [34]
Caudal injection of local anaesthetic, combined preoperative,
18209-08 [36]
Spinal injection of local anaesthetic, combined preoperative,
Note: the advice to default to the assignment of injection, was previously advised in
Victorian ICD Coding Newsletter, November 2000, page 16.
Sedation
92503-00 [1911]
Intravenous sedation, anaesthetist controlled
Anaesthesia and sedation for dental procedure
For sedation
97942-00 [487]
Intravenous sedation for dental procedure
For general anaesthesia
97949-00 [487]
General anaesthesia for dental procedure
Anaesthesia during labour
90486-02 [1333]
1
8
Epidural injection of other therapeutic substance during labour 1
Extracted from NCCH ICD-10-AM, July 2000, General Standards for Procedures.
May be reproduced
HIMAA Education Seminar
Evelyn Robinson, Peninsula Health
The HIMAA Victorian Branch Education Sub-Committee held a very successful
education session on 23 March 2001 at The Centre, Ivanhoe, titled ‘Working with
Coding’.
The first half of the program was a Coding Workshop conducted by Jennie
Shepheard that focused on Associated Conditions, Post-operative Complications and
Diabetes. Participants were sent the workbooks in advance, so they could come
prepared with their answers for discussion. This session was very helpful as it
reinforced a lot of the difficult areas when applying these Standards.
The afternoon session included a panel discussion with speakers from various
hospitals, discussing motivating, auditing and training in a Coding Service. Ruth
Rundell (Geelong Hospital), Patricia Savino (Northern Hospital), Andrea Groom
(Southern Health) and Kathy Wilton (Royal Children’s Hospital) each described the
Coding Service at their hospital. This informative session gave us many ideas on
Coding Allocation and EFT, internal auditing methods, education of coders and
training of new coding staff.
Andrea Groom gave us a brief taste of the ‘Clever Coders’ Cup’ that is held each
month at Southern Health. Participants were split into teams and quiz questions
posed on various coding topics, such as the ‘10-AM Commandments’ section of
‘Coding Matters’ and the Australian Coding Standards.
Other speakers presented examples of the uses of coding and casemix information,
including Adverse Events, Injury Surveillance and Clinical Costing. Dr Mark Stokes,
Director of Victorian Injury Surveillance Systems explained the use of Victorian
Emergency Minimum Dataset data to assist in epidemiological research for injury
prevention. Linda Butcher from the Mercy Hospital for Women discussed clinical
costing and revenue model analysis using ICD-10-AM data.
This education seminar proved very valuable for those Health Information Managers
working in the coding environment and we look forward to future events.
May be reproduced
9
List of Selected ICD-10-AM
Coding Queries
The ICD Coding Committee is an advisory body to Victorian clinical coders and the
Department of Human Services. The Committee does not have the authority to establish
coding standards but offers advice, based on the combined knowledge and experience of
the members and/or the NCCH, in response to individual coding queries. The
Committee’s advice printed in this section of the newsletter can be adopted immediately
unless an introduction date is stated. The implementation of this guidance is advisable as
it sets a precedent for good coding practice. Unless otherwise stated, there is no
expectation that coders should go back to similar episodes already coded differently and
change the coding. It is acknowledged that this might result in a year’s data containing
episodes coded in a non-standard way.
#1622
ACS 1002 Asthma................................................................................ 12
#1636
Colonoscopy: Investigation or finding? ......................................... 13
#1638
Low birth weight................................................................................. 14
#1641
Retained products of conception ..................................................... 16
#1642
Post-infarction angina ........................................................................ 17
#1644
Mechanical complication of ventricular shunt ............................. 17
#1648
Chemotherapy & device loading ..................................................... 18
#1650
Post-procedural complications ......................................................... 18
#1651
Laparoscopic cholecystectomy to open cholecystectomy with
exploration of CBD ............................................................................. 20
#1654
Autologous chondrocyte implantation (ACI)................................ 21
#1658
Smoking related COPD ..................................................................... 22
#1659
ACS 0226 Prostatic cancer.................................................................. 23
#1661
Principal diagnosis in obstetrics ...................................................... 24
#1662
ACS 2103 Admission for Convalescence/ Aftercare..................... 25
#1663
Palliative Care...................................................................................... 25
#1664
Musculoskeletal chest pain............................................................... 27
#1665
Anaesthetic procedures...................................................................... 27
#1669
External cause code - scooters ........................................................... 28
10
May be reproduced
#1671
Osseous metaplasia and Solar lentigo.............................................29
#1676
Follow-up gastroscopy........................................................................30
#1677
Grouping of laparoscopy codes ........................................................30
#1680
Low K+...................................................................................................32
#1682
Underlying condition .........................................................................33
#1685
Ethanol injection..................................................................................33
#1689
ACS 0012 suspected condition (perforation)..................................34
#1691
ACS 0909 Additional procedures performed in conjunction with
CABGs ...................................................................................................35
#1693
Bilateral maxilla and mandible osteotomies with internal
fixation ...................................................................................................36
May be reproduced
11
#1622
ACS 1002 Asthma
ICD-10-AM 1st Edition had a statement within ACS 1002 Asthma - ‘When asthma
and bronchitis are documented for one episode of care, assign only the code for
asthma’. There is no such statement in the 2nd Edition.
Case scenario
Principal diagnosis – 59 year old male admitted with acute bronchitis – infective
cause. Additional conditions – patient also has mild asthma. Treated with
antibiotics and Ventolin.
Does the above statement still apply? There is no entry for ‘Bronchitis – with
asthma’. There is an entry for ‘Bronchitis – asthmatic’, but this is not the diagnosis
supplied, is it the same condition as a patient with bronchitis and asthma (the
dictionary does not seem to help)?
This patient has ‘acute bronchitis and asthma’. There is no further breakdown
under ‘Bronchitis – acute, asthmatic’ or ‘with asthma’. The code for acute
bronchitis:
Acute bronchitis
J20
has no exclusion notes for asthma. The index entry ‘Asthma – bronchitis’ takes us
to:
J45.9
Asthma, unspecified.
Chronic asthma and chronic bronchitis seem well covered by ACS 1008 Chronic
Obstructive Pulmonary Disease (COPD), but I would like some advice on the coding
of ‘Bronchitis NOS with asthma’ and ‘Bronchitis – acute with asthma’. Do you code
it to bronchitis or asthma?
NCCH Response:
The statement ‘When asthma and bronchitis are documented for one episode of care,
assign only the code for asthma’ has been removed in the second edition due to problems
with interpretation. In the case cited assign J20.x Acute Bronchitis as the principal
diagnosis and J45.x Asthma as an additional diagnosis. If a causative organism is
documented, this should also be coded. If a patient has both asthma and bronchitis then
both the conditions should be coded. For example a patient with asthma may get viral
bronchitis. The index entry ‘Bronchitis, asthmatic’ will be reviewed for the third edition
of ICD-10-AM.
12
May be reproduced
#1636
Colonoscopy: Investigation or finding?
Patient admitted for colonoscopy for investigation of anaemia. Colonoscopy found
adenocarcinoma of the colon (sigmoid). What should be the principal diagnosis: anaemia
or cancer? If the cancer should be the principal diagnosis, then can you use:
D63.0
Anaemia in neoplastic disease
instead of
D64.9
Anaemia, unspecified
Please advise which of the following coding options would be assigned, or alternatives if
appropriate.
Option 1:
C18.7
Malignant neoplasm of colon, sigmoid colon
M8140/3
Adenocarcinoma NOS
D63.0
32090-01 [911]
Fibreoptic colonoscopy to caecum with biopsy
92503-00 [1911]
Option 2:
D64.9
Anaemia, unspecified
C18.7
Malignant neoplasm of colon, sigmoid colon
M8140/3
Adenocarcinoma NOS
32090-01 [911]
Fibreoptic colonoscopy to caecum with biopsy
92503-00 [1911]
May be reproduced
13
Coding Matters Volume 6, Number 1, June 1999, page 13, stated that when a patient has
both anaemia and a neoplasm, a cause and effect does not need to be documented; the
words ‘in’, ‘with’ or ‘due to’ neoplastic disease are sufficient in order to assign:
D63.0*
Because this is an asterisk code, the underlying cause (dagger code) is the principal
diagnosis as in your Case 1.
#1638
Low birth weight
Premature male baby delivered at 31 weeks gestation, weight 940gms; small for
gestational age (SGA) due to placental insufficiency. Coded as:
P07.3
Other preterm infants
P05.1
Small for gestational age
P02.2
Fetus and newborn affected by other and unspecified
morphological and functional abnormalities of placenta.
Should code:
P07.1
Other low birth weight
be coded as well as small for gestational age?
Noting the exclusion note under:
Disorders related to short gestation and low birth weight,
P07
NEC
[Excludes: low birth weight due to slow fetal growth and fetal malnutrition (P05.-)],
only
P05.1
is assigned.
Does ACS 0033 Conventions Used in the Tabular List of Diseases, Volume 5 page 15,
Type 2 Exclusion apply to this case?
14
May be reproduced
There are various permutations of prematurity and low birth weight: a baby could be one
or the other or both. Therefore, if both were relevant, two codes would be used, selecting
one from each of the following groups:
P07.2
Extreme immaturity OR
P07.3
and
P07.0
Extremely low birth weight OR
P07.1
Other low birth weight OR
P05.-
Slow fetal growth and fetal malnutrition
In the case given, the two appropriate codes are:
P07.3
P05.1
Because the baby’s low weight problem is adequately indicated by P05.1, there would be
no reason to add P07.1 (no additional information provided by it). Because the cause and
effect have been documented, it would also correct to add:
P02.2
Fetus and newborn affected by other and unspecified morphological
and functional abnormalities of placenta
May be reproduced
15
#1641
Retained products of conception
Patient admitted in a previous episode with diagnosis of ‘Missed Abortion’ and underwent
’Suction Curettage’.
Two weeks later, the patient was admitted with continuous PV bleeding, diagnosis was
‘Retained products of conception (RPOC)’ and underwent a D & C. Histopathology
revealed RPOC.
We have coded as follows:
O04.1
Medical abortion, incomplete, complicated by delayed or excessive
haemorrhage
O09.1
5-13 completed weeks
35643-00 [1267]
Evacuation of contents of gravid uterus
92502-00 [1910]
Intravenous general anaesthesia
ACS 1544, page184 tells us to code as ‘a complication of a current, incomplete abortion
(O03-O06 with a fourth character of .0-.4)’. We are unsure which of these codes to use:
O03.1
Spontaneous abortion, incomplete, complicated by delayed or
excessive haemorrhage
O04.1
Medical abortion, incomplete, complicated by delayed or excessive
haemorrhage
We rejected the following code because of the Exclusion note under it (excludes: retained
products of conception O03-O06):
O08
Complications following abortion and ectopic and molar pregnancy
As the patient is still suffering from a ‘missed abortion’ (and not a complication of
abortion), the principal diagnosis should reflect the original episode’s diagnosis:
O02.1
Missed abortion
It would be useful if ACS 1544 Complications following Abortion and Ectopic and Molar
Pregnancy also covered coding of missed abortions. The Victorian ICD Coding
Committee has sent a request to the NCCH that ACS 1544 is amended to include this
information.
16
May be reproduced
#1642
Post-infarction angina
Question 1 If a patient is re-admitted with post-infarction angina one or two weeks after
the original AMI, should the AMI or the post-infarction angina be sequenced first?
Question 2 ACS 0940 states, ‘if the patient develops postinfarction angina, I20.0 Unstable
angina may be sequenced as an additional code’. Does this line apply only to this
happening in the same episode of care?
In this case, the post-infarction angina was treated and was the reason for the admission.
Question 1 The post-infarction angina would be the principal diagnosis as it was the
reason for admission. Because this is still within four weeks of the AMI, the AMI would
also be coded (see Inclusion note with I21) to:
I21.-
Acute myocardial infarction
Question 2 The quotation from ACS 0940, page 141, applies only when coding the same
episode of care in which the acute myocardial infarction was initially treated.
#1644
Mechanical complication of ventricular shunt
A 52 year old male is admitted with a mechanical complication of his ventricular shunt
and has it revised at the distal peritoneal site. The codes used were:
T85.0
Mechanical complication of ventricular intracranial
(communicating) shunt
Y83.1
Surgical operation with implant of artificial internal device
Y92.22
Health Service Area
90330-00 [1001]
Revision of cerebrospinal fluid shunt at peritoneal site
92502-02 [1910]
Intravenous and inhalation general anaesthetic
These codes seem fine but it is grouping to 901Z Extensive O.R procedure unrelated to
principal diagnosis. Is this a grouping anomaly, as the principal diagnosis does relate
directly to the procedure?
May be reproduced
17
The Commonwealth has been advised of this anomaly, however notification was too late
for inclusion into AR-DRG Version 4.2. This will be considered for version 5 and in the
interim, DRG 901Z is inevitable.
#1648
Chemotherapy & device loading
Should code:
Z45.-
Adjustment and management of implanted device
still be assigned as the principal diagnosis if a patient was admitted to the Chemotherapy
Ward as a same day patient for flushing of vascular access device when chemotherapy is
not administered during the same admission.
If the patient meets the criteria for admission and the only treatment is flushing of the
device, then the principal diagnosis would be:
Z45.-
#1650
Adjustment and management of implanted device
Post-procedural complications
I am writing for further clarification of coding post-procedural complications mainly in
relation to the following statements taken from ACS 1904:
‘... a post procedural complication is defined as:
A condition or injury that is related to a surgical/procedural intervention rather than being
related to the patients disease process.’
An example is a patient admitted for a femoral-popliteal bypass and common femoral
artery endarterectomy. The patient has a past history of ischaemic heart disease (IHD),
having had an AMI 12 months ago with no further chest pain since. The patient
underwent the above procedure and developed angina post-procedurally (on the day of
the procedure) which was treated with Anginine. The patient will now be followed up by
Cardiology. Clinician has documented post-op angina.
Would this be coded as a post-procedural complication?
18
May be reproduced
I97.8
Other postprocedural disorders of circulatory system, not elsewhere
classified
I20.9
Angina pectoris, unspecified
Y83.2
Surgical operation with anastomosis, bypass or graft
Y92.22
Health service area (Place of occurrence)
as it is not an expected outcome of this procedure?
OR is this an expected outcome because the procedure and complication involve the same
body system (circulatory) and therefore coded only to:
I20.9
If this is the case, if the patient underwent a hernia repair instead would we then code it as
a post-procedural complication:
I97.8
Other postprocedural disorders of circulatory system, not elsewhere
classified
I20.9
Y83.8
Surgical operation and other surgical procedures as the cause of
abnormal reaction of the patient, or of later complication, without
mention of misadventure at the time of the procedure, Other surgical
procedure
Y92.22
Health service area (Place of occurrence)
OR is this considered an exacerbation of a previously existing condition (IHD) and
therefore only coded as:
I20.9
That is, ‘related to the patients disease process’. If this is the case, does this mean that all
patients with pre-exiting IHD will never have post-procedural angina coded as a postprocedural complication?
A clinician’s documentation of ‘post op’ does not necessarily mean that the condition is a
complication of the operation (see ACS 1904 Procedural complications). ACS 1904 does not
instruct coders to make decisions based on ‘expected outcomes’; rather, it states a
‘procedural complication’ is ‘A condition or injury which is related to a
surgical/procedural intervention rather than being related to the patient’s disease
May be reproduced
19
process’. In this case, the angina is most likely a progression of the pre-existing disease
process even if the angina had not been diagnosed previously.
The correct code is therefore:
I20.9
#1651
Laparoscopic cholecystectomy to open
cholecystectomy with exploration of CBD
Laparoscopic cholecystectomy converted to open cholecystectomy and then exploration of
the common bile duct. After examining the codes under cholecystectomy, there is no code
that describes all the three features of the surgery. I then decided to code:
30446-00 [965]
Laparoscopic cholecystectomy proceeding to open cholecystectomy
For the exploration of the CBD, I decided to add:
30454-00 [963]
Choledochotomy
But it has an exclusion note that if the exploration is with a cholecystectomy it must be
coded from [965]. My only choice is to use two codes from [965] to reproduce all the
elements of my operative statements but the string of codes reads that I have coded two
cholecystectomies.
In order to capture all information, both codes are required despite the apparent repeat of
one part of the surgery. This has been confirmed by the NCCH’s answers to NCCH
Queries #374 and #471 and in the workbook for the Post Implementation Education
Workshops, March 1999, where arthroscopy for removal of loose bodies requires:
49561-01 [1517]
Arthroscopic meniscectomy of knee with debridement,
osteoplasty or chondroplasty
49561-02 [1511]
Arthroscopic removal of loose bodies with debridement,
osteoplasty or chondroplasty
Note, the Victorian ICD Coding Committee has submitted a request to NCCH for
creation of a Standard that covers this type of double coding.
20
May be reproduced
#1654
Autologous chondrocyte implantation (ACI)
A new procedure, referred to as ACI is being performed at our hospital.
Question 1 Which code do we use for harvesting of cartilage?
Question 2 Which code do we use for the re-implantation?
At present, we are coding the harvesting of cartilage to:
90577-00 [1565]
Procurement of muscle or fascia for graft
90574-01 [1561]
Excision of joint, not elsewhere classified.
We are coding the re-implantation to:
90598-00 [1520]
Other repair of knee
14203-01 [1906]
Direct living tissue implantation.
We are coding the disease to one or other of these:
M22.8
Other disorders of patella
M23.89
Other internal derangements of knee, unspecified ligament or
unspecified meniscus
For this patient, the correct procedure code for the harvesting of cartilage is:
48558-00 [1503]
Arthroscopic debridement of knee
If not performed during a debridement of the knee, harvesting of cartilage could be
coded to:
49557-01 [1502]
Arthroscopic biopsy of knee
If the hospital would like to be able to separately identify these patients, code as an
additional diagnosis:
Z51.4
Preparatory care for subsequent treatment, not elsewhere classified.
The re-implantation of the cartilage is coded to:
49503-02 [1520]
Chondroplasty of knee
14203-01 [1906]
Direct living tissue implantation
May be reproduced
21
A chondroplasty is a plastic repair of the knee. The above code can be located by:
Chondroplasty
-knee (open) 49503-02 [1520]
and
Repair
- knee NEC
- - by
- - - chondroplasty – see Chondroplasty
The diagnosis code for ‘chondral defect’ could be:
M22.9
Disorder of patella, unspecified
This code should be used only if there is no further information about the defect
available. The coder should make an attempt to obtain further information. It may be
that the actual diagnosis is ‘chondromalacia’, in which case the diagnosis code would be:
M22.4
Chondromalacia patellae.
A very useful diagram and explanation of this procedure can be found at
www.thaxter.com/implantation.gif
#1658
Smoking related COPD
Instead of writing, ‘smoking related COPD’ our clinicians sometimes draw an arrow after
the COPD and put smoker or ex-smoker. Alternatively, they write the smoking status of
the patient next to the diagnosis of COPD.
Is this sufficient enough to assign codes:
J44.x
Other chronic obstructive pulmonary disease
F17.1
Mental and behavioural disorders due to use of tobacco – harmful
use
Or does the exact causal relationship between COPD and smoking have to be
documented?
22
May be reproduced
Before COPD can be coded, it must meet ACS 0002 for additional diagnoses. The
Committee considered that the above illustration would be sufficient indication that the
condition was due to smoking.
Sufficient indication of relationship
Not an indication of relationship
•
COPD/smoker
•
COPD
•
HT
•
HT
•
CCF
•
CCF
•
Smoker
•
COPD/smoker
•
CCF
COPD/CCF/AF/DM/Smoker
COPD ← smoker
Smoker →COPD
#1659
ACS 0226 Prostatic cancer
Just wishing to confirm that, following the deletion of ACS 0226 Prostatic Cancer from 2nd
edition ACS, that any history of prostate cancer (meeting additional diagnosis standards, of
course) would now be coded to:
Z85.4
Personal history of malignant neoplasm of genital organs
regardless of previous surgery type.
NCCH Query #1341 answer states that ACS 0226 Prostate cancer (1st edition) is still
clinically relevant. Therefore, prostate cancer patients who have had a non-radical
prostatectomy/TURP should be assigned code C61 Malignant neoplasm of prostate, not a
Z85.- code, as these patients still have prostate cancer in the remaining prostate tissue.
The NCCH will consider the reintroduction of a similar ACS.
May be reproduced
23
#1661
Principal diagnosis in obstetrics
This is a general query regarding determination of the principal diagnosis in obstetric
cases, but an example to illustrate is:
Prolonged pregnancy for medical and surgical induction, progresses to vacuum extraction due to
compound presentation, followed by suture of 1st degree perineal laceration.
Should the principal diagnosis be the prolonged pregnancy (reason for admission) or the
compound presentation (reason for vacuum extraction)?
There is variation amongst coders about the choice for principal diagnosis. Some coders
sequence conditions in chronological order, whilst others identify the major procedure and
then match the principal diagnosis to that.
We note the HIMAA coding course textbook instructs that the principal diagnosis is that
related to the actual delivery itself (presumably in our example above, the compound
presentation and vacuum extraction).
There are two queries on the NCCH database that deal with this issue. Query #174 and
#877 that state there are no strict rules with regard to assigning principal diagnosis unless
the patient is admitted antenatally. The sequence of diagnosis codes is not significant for
grouping, however coders should ensure that important diagnosis codes are transmitted
to the VAED, if there are a large number of codes for one patient. The most significant
procedure should be sequenced first.
24
May be reproduced
#1662
ACS 2103 Admission for Convalescence/
Aftercare
I seek clarification on application of ACS 2103 Admission for Convalescence/Aftercare, in cases
of aftercare following medical (as against surgical) treatment for a condition.
Sample case:
Patient transferred back to our hospital following overnight treatment in a larger hospital Accident
and Emergency department for fractured vertebra post MVA. Medical investigation only at larger
hospital, 4 weeks medical treatment at our hospital. Is the principal diagnosis the aftercare or the
medical condition?
ACS 2103 has been modified in the 2nd edition, but this was not highlighted in the
Education Workshops (Appendix B, Workbook list of changed Standards does not mention
ACS 2103).
The change affects coding of cases of aftercare following medical (as against surgical)
treatment of a condition, with the changed wording suggesting that the condition is coded
as an additional diagnosis now whereas the first edition instruction was ‘assign the code
for the condition…’ for these cases.
As the patient was clearly given medical treatment at your hospital, this is not an
admission for convalescence or aftercare, but rather an acute medical admission.
Therefore ACS 2103 does not apply in this case.
#1663
Palliative Care
What is the principal diagnosis for each of the following admissions to our palliative care
unit?
Case One
77 y.o female with stage 3 ovarian cancer presented with 4/52 upper abdominal pain for
‘symptom control’ (in one place in the record) and ‘investigation and treatment’ (in
another). May need endoscopy, +/- CT abdo to elucidate cause of pain. Previously started
on Ranitidine because of dyspepsia. Investigations not carried out, and patient’s pain
settled over a few days.
May be reproduced
25
Case Two
35 y.o. male with metastatic (lung and spinal cord) psoas muscle sarcoma presenting with
increasing pain for symptom control. Quadriplegic due to spinal cord compression from
mets. This admission, presents with low back pain, constipation, increased right arm
weakness and twitching, and partially treated E. Coli UTI. Deteriorating condition.
Treated with morphine, Clonazepan and Augmentin.
Case Three
45 y.o. male with frontal oligodendroglioma, admitted with nausea and vomiting and
increasing debility for symptom control. Increasing nausea probably due to increased
intracranial pressure. Has had dizziness, nausea, occasional headache, unsteady on feet
for months. Treated with Maxolon, steroids, ranitidine, haloperidol.
Case Four
43 y.o. male with metastatic thymic carcinoid tumour (extensive secondaries in bone –
pelvis, ribs, sternum, orbits, thoracic and lumbar spine and brain) presents with severe low
back and hip pain for treatment/symptom control. Also dehydrated and constipated.
Treated with pain control medications.
ACS 0224 Palliative Care states ‘A principal diagnosis code should be assigned which
reflects the diagnosis resulting in the relatively shortened prognosis’, thus for patients
admitted to a Palliative Care Unit (and therefore admitted specifically for palliative care)
the diagnosis should be the terminal condition. As this is a palliative care unit, it is easy
to determine that the patient has been admitted for palliative care. When a terminally ill
patient is admitted to an acute setting, care should be taken to determine the reason for
admission. If the intent for the admission is for palliative care, ensure that ACS 0224 is
followed. If the admission is for symptomatic care, ensure that ACS 0001 is followed
when assigning the principal diagnosis.
26
May be reproduced
#1664
Musculoskeletal chest pain
How should we code musculoskeletal chest pain?
R07.4
Chest pain, unspecified
R07.3
Other chest pain
M79.18
Myalgia, other
The correct code for musculoskeletal chest pain is:
R07.3
Other chest pain
Although the Index at Pain – chest does not give a code for ‘Other’, reference to the
Tabular indicates that R07.3 is a better code than R07.4 as this chest pain is specified as
musculoskeletal’.
The Index also provides:
Pain
- muscle M79.1- chest
- - anterior wall R07.3
#1665
Anaesthetic procedures
Would we code both epidural and spinal anaesthesia, in this case given for elective LUSCS
(no anaesthesia during labour)? According to our anaesthetists, this is being done more
often for ‘better anaesthetic cover’.
ACS 0031 Anaesthesia (page 35) gives a hierarchy for coding anaesthesia but epidural,
spinal and cannula are on the same level (iii).
Query #1294 on the NCCH Query Database advises that both codes are assigned. The
spinal anaesthesia provides fast pain relief while the epidural provides longer relief.
May be reproduced
27
#1669
External cause code - scooters
The patient had a fall from an ‘unmotorised scooter’.
We have currently coded this to
W02
Fall involving ice-skates, skis, roller-skates or skateboards
Owing to its proximity to a skateboard.
We have checked the Coding Query Database and tried all the index possibilities
but have come up with no further clarification.
It appears that accidents involving people riding scooters are not automatically assigned
to W02.
The term ‘pedestrian’ in Definitions Related to Transport Accidents (vol 1, page 444)
includes a person riding a scooter as a user of a ‘pedestrian conveyance’. It was noted
that, if the person falls from the scooter, the correct code is:
W02
Fall involving ice-skates, skis, roller-skates or skateboards
If the fall results from collision with another person, the correct code is:
W03
Other fall on same level due to collision with, or pushing by,
another person
Includes: fall due to collision of pedestrian (conveyance)
with another pedestrian (conveyance)
However, the Table of Land Transport Accident (vol 2, page 420), under pedestrians,
provides the following External Cause codes:
For a person on a scooter colliding with another person:
W51
Striking against or bumped into by another person
For a person on a scooter striking a stationary object:
W22
28
Striking against or struck by other objects
May be reproduced
#1671
Osseous metaplasia and Solar lentigo
I need advice on how to code:
1. Osseous metaplasia
2. Solar Lentigo
I have used the following codes:
L98.9
Other specified disorders of skin and subcutaneous tissue
L81.4
Other melanin hyperpigmentation
Please review ACS 0033 and 0034 for the use of modifiers and inclusion terms.
Osseous metaplasia is a bone condition (histology report would indicate this). Follow the
index:
Disorder
- bone
- - specified type NEC
and use code
M89.8- Other specified disorders of bone.
Solar Lentigo is coded to:
L81.4 Other melanin hyperpigmentation.
Inclusion terms are not exhaustive, and coding convention permits the use of general
terms to describe a condition if there is no essential modifier present to further clarify the
term.
May be reproduced
29
#1676
Follow-up gastroscopy
A patient comes in for follow-up gastroscopy to check on ulcerative oesophagitis and
hiatus hernia.
Patient had been treated with Losec. On follow-up gastroscopy, only hiatus hernia is
found. Would I use the new standard ACS 2111 Screening for Specific Disorders and
code the appropriate:
Z09.-
Follow-up examination after treatment for conditions other than
malignant neoplasms
then the hiatus hernia code or would I just code the condition found.
Investigation by the Coding Committee indicates that the Losec would be given for
treatment of the ulcerative oesophagitis. As the follow-up gastroscopy was to check the
resolution of the ulcerative oesophagitis, which had resolved, the principal diagnosis
code should be:
Z09.8 Follow up examination after other treatment for other conditions.
Other codes to use are:
Z87.18 Personal history of other digestive system disease
K44.9 Diaphragmatic hernia
and the appropriate endoscopy procedure code. ACS 2111 cannot be applied in this case,
as ‘screening is the testing or examination for disease or disease precursors in
asymptomatic individuals’, and ‘codes….should be assigned as the principal diagnosis
when a patient is examined for a particular disease or disorder when the disease for
which the patient is being screened is not detected or has never been detected’ (ACS
2111). As this patient has a known past history of a condition this standard does not
apply.
#1677
Grouping of laparoscopy codes
Patient admitted with duodenal obstruction caused by cancer of pancreatic body
diagnosed on CT, for gastrojejunostomy. Surgeon performed laparoscopy first and
then converted to an open procedure.
30
May be reproduced
For grouping, when procedure codes include laparoscopy:
•
H05A Hepatobiliary diagnostic procedures with Catastrophic/Severe CC [mean LOS
10.8, weight 3.3610].
Without laparoscopy:
•
H06Z Other hepatobiliary & pancreas OR procedures [mean LOS 17.0, weight
5.1595].
Diagnosis codes were:
C25.1
Malignant neoplasm of body of pancreas
M8140/3
Adenocarcinoma NOS
K56.6
Other and unspecified intestinal obstruction
E87.6
Hypokalaemia
C83.3
Diffuse non-Hodgkin’s lymphoma, large cell (diffuse)
M9680/3
Malignant lymphoma, large cell, diffuse, NOS
D56.8
Other thalassemia
Groups to H06Z Other hepatobiliary & pancreas OR procedures without laparoscopy:
30515-00 [881]
Gastro-enterostomy
Groups to H05A Hepatobiliary diagnostic procedures with catastrophic/Severe CC with
laparoscopy:
30515-00 [881]
Gastro-enterostomy
30390-00 [984]
Laparoscopy
Laparoscopic code takes grouping to diagnostic procedures, which is incorrect.
Do we need a new code for "converted from? to.. " or separate laparoscopic code
for gastrojejunostomy? Which codes do I use for now?
This problem exists in several areas of the grouper logic (for example MDC 13, female
reproductive system) and in cases of long stay medical patients who have a minor
diagnostic procedure during their stay. The problem occurs because of the surgical
hierarchy.
May be reproduced
31
Because there are not enough patients having gastroenterostomy to justify a specific DRG
for gastroenterostomy, these patients are allocated to the ‘other’ DRG. On the other hand
there are many patients who have a diagnostic procedure and the creation of a DRG for
these patients is justified.
Consequently, when a patient who would otherwise be allocated to the ‘other’ DRG has a
procedure that is listed for any one of the specific DRGs, the case will move into the more
specific DRG. Most of the time, this works in favour of the hospitals. The diagnostic
DRG is often the exception.
This logic can be easily studied in the flow charts at the beginning of the MDC 7 chapter
in Volume 1, page 250 of the version 4.1 definitions manual.
The Department of Human Services has sent a submission to the Commonwealth for
consideration. In the interim, your suggested codes are correct.
#1680
Low K+
Is the documentation (recorded by the clinician) of ‘Low K+’ sufficient for coding:
E87.6
Hypokalaemia
Patient was admitted for closure of ileostomy, ‘Low K+’ documented and patient
commenced on Slow K.
This is an accepted medical abbreviation. As the patient has been put on medication for
this condition, the hypokalaemia may be coded. The term ‘low’ is acceptable terminology
indicating hypokalaemia.
This could also be indicated by a down pointing arrow.
Similarly the term ‘high’ or an up pointing arrow are acceptable terminology.
32
May be reproduced
#1682
Underlying condition
Do you code the underlying condition when the condition being coded is not the
principal diagnosis?
ACS 0001 instructs to assign the underlying condition in addition when you are
coding the ‘problem’ – but this is for principal diagnosis.
Two examples are for patients admitted for other conditions but have End Stage
Renal Failure due to reflux nephropathy and liver failure due to cirrhosis. The
nephropathy and cirrhosis do not meet ACS 0002, on their own.
Only code those that meet the definition of ACS 0001 and ACS 0002. Except where the
specialty Coding Standards override, coders should not code ‘packages’ of diseases. If
the components are active and are being actively treated, these may be coded, otherwise
code only the treated conditions.
#1685
Ethanol injection
Please advise on how to code endoscopic ethanol injections of a non-bleeding
angiodysplastic stomach lesion.
I have coded this as:
30473-00 [1005]
Panendoscopy to duodenum
92193-00 [1885]
Injection or infusion of other therapeutic or prophylactic
substance
92503-00 [1911]
This groups to:
G45B
Other gastroscopy – Non major digestive disease, same day
If I were to use code:
30478-07 [870]
Endoscopic sclerosing injection of bleeding gastric or duodenal
lesions
May be reproduced
33
this would group (I believe inappropriately) to:
G41B
Complex therapeutic gastroscopy – Non major digestive disease,
same day
I do not believe the code is correct as the lesion is not, and has not been bleeding. I
cannot find a code that accurately reflects this procedure. There is no code for injection
of non-bleeding lesion of the stomach and I am also unsure if ethanol is considered a
sclerosing agent.
On investigation, we find that ethanol is a sclerosing agent, therefore the Coding
Committee recommends the use of code:
30478-07 [870]
Endoscopic sclerosing injection of bleeding gastric or duodenal lesions
The Coding Committee will lodge a public submission to the NCCH suggesting the
removal of the term ‘bleeding’ from the code descriptor, or the creation of a new code for
injection of non-bleeding lesions. It was noted that the index for injection of varices leads
to ‘non-bleeding’ for oesophagus and oesophago-gastric sites whilst it leads to ‘bleeding’
for gastric and duodenal sites.
#1689
ACS 0012 suspected condition (perforation)
7/9/00: Colonoscopy with biopsy performed for diarrhoea for investigation;
Outcome: mild colitis – Discharged home.
8/9/00: Presented with abdominal pain, post colonoscopy and fever (perforation??)
Settled with IV antibiotics – Discharged home 9/9/00 with script for Keflex.
Suggested code:
K52.9
34
Colitis
May be reproduced
We reviewed ACS 0012 Suspected Conditions ‘if treatment is initiated, and
investigation results are inconclusive, assign a code for the suspected condition’ and
ACS 1904 Procedural Complications ‘some transient conditions occur in the post
procedural period but are not regarded as post procedural complications.’
Suggested codes for 7/9/00:
K52.9
Noninfective gastroenteritis and colitis, unspecified
32090-01 [911]
Fibreoptic colonoscopy to caecum, with biopsy
Anaesthetic code as appropriate
Suggested codes for 8/9/00 (on the basis of the above information)
R10.4
Other and unspecified abdominal pain
R50.9
Fever, unspecified
The documentation (as quoted) does not support the coding of perforation of colon. The
Keflex is more likely to be treatment for the colitis or fever and not necessarily a standard
treatment for colon perforation.
#1691
ACS 0909 Additional procedures performed in
conjunction with CABGs
Should Swan-Ganz catheterisation and intra-operative transoesophageal
echocardiogram (TOE) be coded in conjunction with a CABG procedure? Are they
a routine part of a CABG procedure and as such are codes not required for these
components?
In view of ACS 0909 Coronary artery bypass grafts that says not to code other routine
procedures performed with CABGs, the Committee considers that these are a part of the
CABGs procedure and therefore should not be coded.
May be reproduced
35
#1693
Bilateral maxilla and mandible osteotomies
with internal fixation
It appears there are two possible ways of coding bilateral maxilla and mandible
osteotomies with internal fixation.
Example 1
45722-01 [1706] Osteotomy of maxilla with internal fixation, bilateral/Le Fort
osteotomy with internal fixation
45722-00 [1706] Osteotomy of mandible with internal fixation, bilateral
Example 2
45746-00 [1708] Osteotomies or ostectomies of mandible and maxilla, 4 procedures
with internal fixation
I believe Example 1 provides a greater level of specificity as to where the procedures
were actually performed, that is, how many osteotomies were performed on the
maxilla versus how many were performed on the mandible.
Confusion also arises in the counting of the procedures. Are we only counting the
number of osteotomies and ostectomies? Are there other procedures that we should
be counting as well (eg genioplasty, bone grafts) if performed?
In the above case there are no other procedures to count except the number of
osteotomies, so what codes are to be used?
The Committee recommends following the index entry:
Osteotomy
- maxilla
- - multiple procedures
- - - with
- - - - multiple ostectomies or osteotomies of mandible, in combination — see block [1707]
36
May be reproduced
Coding Corkboard
Coding Newsletter Mailing List
Currently the Victorian Coding Newsletter is freely distributed to hospitals. As it is
planned that the hard-copy printing and posting of the Newsletter will be phased out, we
are seeking your help to update our ‘mailing list’.
Once our mailing lists have been updated, it is our intention to post only one hard copy
newsletter to each Victorian hospital. If you have a special need to receive a hard copy
newsletter, please send your request to the Secretary, Victorian Coding Committee via fax
or email as detailed below.
The Newsletter will still be available via the Health Data Standards and Systems Unit
website http://www.dhs.vic.gov.au/ahs/hdss/newslett.htm however you will now
have the opportunity to receive your own copy via email.
For each person wishing to receive their own electronic copy of the Coding Newsletter,
please email your contact details to the Secretary, Victorian Coding Committee:
[email protected]
Alternatively, please fax the ‘Coding Newsletter Email Subscriber Form’ (enclosed inside
back cover of this Newsletter) to the Secretary, Victorian Coding Committee on:
(03) 9616 7629
May be reproduced
37
Health Funds and Australian Coding Standards
The Victorian ICD Coding Committee requests that hospitals send details of any instance
of a health fund requiring a hospital to provide ICD codes in a format that does not
follow the Australian Coding Standards (for example, requesting codes in a different
sequence or not accepting a Z code as principal diagnosis). We will refer instances to the
National Centre for Classification in Health; ultimately, these matters will be taken up
with the Australian Health Insurance Association (AHIA).
For each instance, please provide the Secretary of the Victorian Coding Committee with
the following details:
•
Name of contact and contact details (for example, email address)
•
Name of hospital
•
UR Number and separation date of episode
•
Name of health fund (and, if possible, name or title of employee)
•
Description of unresolved problem with health fund
[email protected]
Secretary, Victorian ICD Coding Committee
38
May be reproduced
Websites
New Zealand Health
www.nzhis.govt.nz/publications/coders-current.html
Information Service (nzhis)
(Previous issues available via a link at the top of each
Coders’ Update
issue)
Just Coding - a US web site
www.justcoding.com
with useful articles, quizzes, etc
RxList - an internet drug index
www.rxlist.com
Australian Institute of Health
www.aihw.gov.au
and Welfare (AIHW).
In particular, a range of publications using hospital data:
AIHW’s newsletter Access is
www.aihw.gov.au/publications/health.html
available at this site.
Handbook of Medical
www.mihandbook.stanford.edu/handbook/home.htm
Informatics (UK) – contains
coding quiz in Q&A section
May be reproduced
39
Information Updates
Data Quality
Audits of VAED Data
1999–2000
The Final Report for the 1999–2000 audit of VAED data was posted to the DHS website in
January. It is password protected. All public hospitals were notified of access codes in a
letter sent to CEOs in January, which also advised of the commencement of the 2000–2001
audits.
2000–2001
The audit of 2000–2001 VAED data commenced in December 2000. This is a Year one
audit within the two year audit cycle, and as such will provide a statewide audit result, as
hospitals will be selected from all groups, and metropolitan and rural locations.
Methodology will be consistent with that used in the previous two years of this project,
updated to the second edition of ICD-10-AM, AR-DRG v4.1 and WIES8.
Data will mostly be drawn from the first three quarters of 2000–2001, however data from
the final quarter of the 1999–2000 financial year have been reviewed at some sites, and
data from the final quarter of 2000–2001 will be used at others. In all instances, the most
recent available data will again be examined.
Hospital Selections - Random, Follow-up, Supplementary - and Targets
Some 7,700 episodes will be reviewed at the 56 sites randomly selected for audit of an
‘annual’ sample. Four sites audited in 1999–2000 had results warranting ‘follow-up’
audit in this round. Sample sizes at these four sites will be larger, and designed to
achieve statistically significant results, with a total of 1,830 episodes to be assessed. Of
the 12 sites where follow-up audits were conducted last year, results at seven remained
outside previously set parameters, and ‘supplementary’ audits (as provided for in the
Policy and Funding Guidelines) will be conducted on 700 episodes at these sites. In
addition, two target audit topics have been identified: coding of 500 ‘sick neonate’
episodes will be examined across 14 sites, while the results of the Dual Coding Study will
40
May be reproduced
be verified at nine sites. These target sites may be involved in the audit either as ‘annual’,
‘follow-up’ or ‘supplementary’ sites, or may just be selected for one or both audits of
target data. By mid April, about 26 sites had been audited of the 71 sites to be involved
in the audit of 2000–2001 VAED data. A further 25 sites should be completed by the end
of June, with the remainder to be audited before mid September, when visits are
scheduled to be completed.
Queries
Any queries about the VAED audits should be directed to Joanne McLachlan (9616 7710)
or Mark Gill (9616 7456), rather than HMA or auditors.
May be reproduced
41
A review of Newborns – Qualified but no condition coded
Irene Kearsey, Department of Human Services
Purpose of data study
Some newborn episodes in the Victorian Admitted Episode Dataset (VAED) are reported
as acute but with no condition coded (the only diagnosis code being for birth outcome).
Whether the newborn is Qualified or Unqualified makes no difference to the casemix
payment the hospital receives. However, there are two important reasons why the
Department needs the Qualification Status (and therefore the Care Type) to be correct:
•
Put simply, the Department reports Acute Care episodes to the Commonwealth to
secure Victoria’s share of Medicare funding and does not report Unqualified
episodes; the Department can be audited and must be seen to make every attempt to
provide accurate data.
•
If the postcode for an Acute Care episode is interstate, the Department bills the
relevant interstate health authority for that admission; if the coding seems to indicate
there was no justification for an “admission” (for example, a newborn with no code
that indicates a diagnosis), an interstate health authority will not pay and the
Department cannot recover costs.
There are three criteria for a newborn to be Qualified:
•
Second or subsequent live born of a multiple birth
•
Admitted to a Neonatal Intensive Care Unit/Special Care Nursery
•
Remains in hospital without the mother
The Z38.- code can indicate a multiple birth and an additional diagnosis code can indicate
the absence of the mother in certain circumstances. In almost every circumstance, the
reason for time in a Neonatal Intensive Care Nursery/Special Care Nursery (NICU/SCN)
can be indicated by a diagnosis code. The only explanation for the absence of such a
diagnosis code would be if the newborn had a condition that caused him/her to be
moved to the NICU/SCN but this could not be coded because the circumstances did not
justify coding it according to ACS 1615 Specific interventions for the sick neonate.
42
May be reproduced
Details of data search
Using the 2000-2001 VAED (December Consolidation), I extracted all newborn episodes
where the only diagnosis code is Z38.0 Singleton, born in hospital but the Care Type
is 4 Acute (rather than U Unqualified newborn). I sent each hospital reporting any such
episodes a list of the records and asked for an investigation and report back on the
circumstances.
I also looked at the Criterion for Admission because, if the diagnosis coding were correct
(for example, the baby had no problem), the Criterion for Admission should be U
Unqualified newborn. If the mother left the hospital before the baby (that is, during the
episode, the baby became qualified causing the Care Type to became Acute), the Criterion
for Admission should remain U (rather than be N Qualified newborn).
Results – Summary
The initial extract of episodes containing a Z38 Newborn code produced 18,808 records
(remember, this was the December consolidation so less than half a year’s records were
coded). Of these, 18,221 were Z38.0 Singleton, born in hospital. The final extract found 151
records with Care Type 4 Acute where the only diagnosis code was Z38.0 Singleton, born
in hospital (0.8%). Although this is a tiny percentage, action to correct anomalies is still
worthwhile.
The following table summaries the numbers of records per hospital:
Hospitals with records Records each
found in this extract
6
1
3
2
4
3
1
5
1
6
2
9
2
10
1
30
1
48
Total hospitals 21
Total records 151
May be reproduced
43
Of the 151 records, 4 records (2.6%) had Criterion for Admission U Unqualified newborn at
admission. The other 147 records (97.4%) had Criterion for Admission N Qualified
newborn (ie, Qualified at time of birth rather than becoming qualified because, for
example, the mother had left the hospital).
After the initial mail-out and one follow-up, four hospitals did not respond, representing
1 record, 3 records, 5 records, and 48 records respectively (57 records in all). Seventeen
hospitals that did respond represented 94 records.
The 94 records were identified as those with incorrect Care Type and those with missing
diagnosis code, according to the hospitals’ responses:
Incorrect Care Type
13
13.8%
Missing diagnosis
81
86.2%
Total
94
Some hospitals did not indicate what the additional diagnosis was, just that the newborn
had been in the Special Care Nursery. For 89 records, the hospital indicated the missing
diagnosis.
No hospital reported an episode where the explanation was that the mother left the
hospital before the newborn.
Results – Care Type
Generally, the allocation of qualification status for newborns is outside the control of the
Health Information Manager but this review gave hospitals the chance to discuss the
issue with those who do record this. For three hospitals, incorrect Care Type was the
explanation for all their problem records.
One episode (total length of stay four days) ended, at the patient’s request, with two days
of Hospital in the Home. When the hospital transferred the mother and her (Unqualified)
baby to HITH, the hospital changed the baby’s Care Type to Acute because the in-house
system had no account code for Unqualified HITH. This is an incorrect change. The
hospital should create an account code (or separate the baby from the date of leaving the
hospital – although the circumstances, as given to me, would justify reporting the HITH
days for the baby). See ‘Purpose of data study’ above for reasons why the Department
needs the Care Type to be accurate.
44
May be reproduced
Results – Diagnosis coding
Of the records with missing diagnosis codes, the following summarises the conditions
that had been overlooked in a number of the records (with the Australian Coding
Standard, where one applies).
Maternal diabetes
Look at ACS 1602 Neonatal complications of maternal diabetes
If the laboratory report and the clinician confirm the newborn had at least a
transient decrease in blood sugar that can be attributed to the maternal condition,
you should assign, with the Z38 code, one of the following:
P70.1
Syndrome of infant of a diabetic mother
P70.0
Syndrome of infant of mother with gestational diabetes
Baby needs more care than normal because of some maternal cause
Look at ACS 1609 Maternal causes of perinatal morbidity and mortality and Coding Matters
Volume 7, Number 3, December 2000 Newborns affected by maternal causes
If a baby requires more care than normal because of a maternal cause, you should
assign, with the Z38 code, a code from the following plus a code for the effect on the
newborn (sequenced first):
P00
Fetus and newborn affected by maternal conditions that may be unrelated to the
present pregnancy
P01
Fetus and newborn affected by maternal conditions of pregnancy
P02
Fetus and newborn affected by complications of placenta, cord and membranes
P03
Fetus and newborn affected by other complications of labour and delivery
P04
Fetus and newborn affected by noxious influences transmitted via placenta or
breast milk
Observed post-caesarean – no ill-effect
Look at ACS 1609 Maternal causes of perinatal morbidity and mortality
If a baby is observed post-caesarean but suffers no ill-effect, you should assign, with
the Z38 code:
Z76.2
Health supervision and care of other [than foundling] healthy infant and child
May be reproduced
45
Observed for suspected condition, such as sepsis
Look at ACS 1611 Observation and evaluation of newborn for suspected condition not found
If an otherwise healthy newborn is suspected to be at risk of an abnormal condition
but, after examination and observation, there is no need for further treatment or
medical care, you should assign, with the Z38 code:
Z03.8 Observation for other suspected diseases and conditions
Mother not able to care for baby
Look at ACS 1615 Specific interventions for the sick neonate – Maternal illness/incapacity to
care:
If the newborn is exclusively dependent on nursing care for more than 24 consecutive
hours, you should assign, with the Z38 code, a code to indicate the reason for the
baby requiring care. Examples include:
Z02.8
Other examinations for administrative purposes [baby for adoption]
Z76.2
Health supervision and care of other [than foundling] healthy infant and child
[mother transferred to ICU or to another hospital, causing the baby to be
cared for in SCN]
Of the other conditions that had been overlooked, the following were mentioned by more
than one hospital:
•
Prematurity
•
Respiratory distress
Summary
Some hospitals commented on the exercise:
•
“We have … spoken to the Resident Doctors about the diagnosis and to give a reason
why the baby was in Special Care Nursery. I hope this will eliminate cases of this
kind in the future.”
•
“This proved to be a very useful exercise and promoted much discussion amongst
our coding team. Please continue with this type of feedback.” This hospital is also
investigating an internal mechanism for checking this on a routine basis within the
hospital.
46
May be reproduced
Action for preventing this from occurring
•
Liaise with NICU/SCN clinicians to ensure comprehensive documentation.
•
Liaise with administrative staff responsible for assigning Care Type to ensure rules
are followed.
Acknowledgement
I thank the hospitals for their efforts in reviewing their records and reporting back.
Because the VAED is still ‘live’ for these episodes, hospitals have been able to revise their
data (which would have increased WIES in some episodes). For all of these episodes, the
hospital’s PRS/2 Control Report would have given Warning message 403 Qualified
newborn without justification. This exercise demonstrates that it is unwise to ignore
warning messages.
Dual Coding Study Results
Additional Diagnoses and Post Procedural Complications
Mark Gill, Department of Human Services
Throughout this financial year a Dual Coding Study has been conducted to assess the impact
of two significant changes to Australian Coding Standards (ACS) 0002 Additional Diagnosis and
1904 Procedural Complications.
The Department recognised that these revised coding standards could adversely affect
the funding of Victorian public hospitals through significant numbers of episodes
grouping to ‘non-CC’ DRGs, when previously they would have grouped to ‘with CC’
DRGs. The Dual Coding Study was designed to identify and manage this effect and the
Department indicated it would not penalise hospitals for failing to reach agreed WIES8
levels where the shortfall could reasonably be attributed to the effect of modified ACS
0002 and ACS 1904.
The Victorian Advisory Committee on Casemix Data Integrity (VACCDI) has overseen
the Dual Coding Study which has involved nine volunteer hospitals (the Alfred, Monash,
St Vincent’s, Ballarat, Warrnambool, Wangaratta, Goulburn Valley, Stawell and
Kyabram) coding 2000-2001 separations in accordance with both the 1999-2000 and 2000May be reproduced
47
2001 applications of the coding standards. This data were then matched to data held by
the Department to simulate funding differences and to derive WIES8 reduction factors.
The Dual Coding Study has confirmed that WIES8 has been reduced by the modification
to coding standards. Based on the initial results from four hospitals (A1, B1, C1, C2),
Coding Standards WIES8 Adjustment Factors were set at 1.025 for A hospitals, 1.0125 for
B hospitals and 1.007 for C,D,E hospitals.
The Department gathered information from five more hospitals and together the results
show significant differences between hospitals from the same hospital group. There are
two main reasons for this: (i) statistical analysis from the VAED Audit suggests high
sampling variability in regard to WIES; and (ii) differences in hospital coding in regard to
these standards, particularly before, and possibly after the modifications. More
information will be available on the latter effect, and any reconsideration of the factors
will occur, after the Dual Coding Study results have been examined within the 2000-2001
phase of the VAED audit.
The Dual Coding Study results are shown below:
DUAL CODING STUDY, VICTORIA, 2000-2001
(modified additional diagnoses and post procedural complications coding standards)
HOSPITAL
BY GROUP
RECORDS
DUAL CODED
% DRG
CHANGE
% WIES
CHANGE
A1
900
7.3
-2.84
A2
500
3.2
-0.76
A3
1349
2.8
-0.81
B1
741
2.1
-0.92
B2
500
3.8
-2.45
B3
500
3.8
-1.60
B4
457
3.5
-1.95
C1
254
1.6
-0.70
C2
269
0.7
-0.24
48
May be reproduced
Reporting To The VAED
AR-DRG Modifications (2001-2002)
As notified in HDSS Bulletin 20, Victoria will move to AR-DRG Version 4.2 for casemix
funding of Victorian Public Hospitals for separations occurring on or after 1 July 2001.
A list of the changes between Version 4.1 and Version 4.2 is available from the
Commonwealth Department’s website at: www.health.gov.au/casemix/dev42.htm
Details of software availability are located at: www.health.gov.au/casemix/grouper1.htm
The new AR-DRG Version 4.2 Manual consists of the existing three-volume AR-DRG
Version 4.1 Manual, plus a new Volume 4, which can be ordered from the National
Centre for Classification in Health.
The following is an excerpt from the Victoria — Public Hospitals Policy and Funding
Guidelines 2001–2002:
In 2001-2002, hospitals will assign diagnoses and procedure codes using the 2nd
edition of the ICD-10-AM classification. For funding purposes, these codes will be
grouped using AR-DRG Version 4.2 (no mapping required).
As in previous years, some adjustments are to be made to the original AR-DRG4
(Version 4.2) grouping utilising the VIC-DRG4 field, prior to the calculation of
WIES9. Some of the AR-DRG Version 4.1 adjustments applied in WIES8 (bilateral
hip replacement and bilateral knee replacement; hook needle localisation of breast
lesion; retained placenta and membranes without haemorrhage; paraurethral
injection; care of lactating mother; and post natal depression) are no longer
necessary as the anomalies have been rectified in AR-DRG Version 4.2.
The VIC-DRG4s for WIES8 for Peritoneal dialysis, Radiotherapy, Bone Marrow
Transplants and Admission weight remain for WIES9. The VIC-DRG4s for
Nasopharyngeal intubation and Arteriovenous fistula have been modified for
WIES9.
May be reproduced
49
Peritoneal dialysis
In recognition of cost differences between peritoneal and haemodialysis, episodes
with a principal diagnosis of peritoneal dialysis (ICD-10-AM code Z49.2) are to be
assigned a VIC-DRG4 of L61Y Admit for peritoneal dialysis.
Radiotherapy
Victorian Coding Standard 0229 states that non-same day patients receiving
radiotherapy should have the malignant condition sequenced first, followed by the
radiotherapy code (ICD-10-AM code Z51.0). Same day radiotherapy admissions,
which follow the Australian Coding Standard, have Z51.0 assigned as the principal
diagnosis followed by the malignancy code.
To maintain funding equity, a VIC-DRG4 of R64Z Radiotherapy will be assigned for
non-same day, non-surgical episodes that include a radiotherapy diagnosis code
(grouped as if the radiotherapy code is the principal diagnosis).
Bone Marrow Transplants
In recognition of cost differences between allogeneic and autologous bone marrow
transplants, AR-DRG4 A04Z Bone marrow transplant is split into VIC-DRG4 A04A
Allogenic bone marrow transplant and A04B Non-allogenic bone marrow transplant.
Any cases grouped to AR-DRG4 A04Z with ICD-10-AM 2nd edition procedure
codes of
13706-00, 13706-06, 13706-09, or 13706-10 are allocated to VIC-DRG4 A04A and all
other cases originally grouped into AR-DRG4 A04Z are allocated to VIC-DRG4
A04B.
Admission weight
In AR-DRG Version 4.2, admission weight must be between 400 and 9999 grams
otherwise the episode will be assigned to AR-DRG 960Z Ungroupable. The
Department has been notified of live births where the baby weighs significantly less
than 400 grams.
Episodes with an admission weight between 125 and 399 grams are assigned an
admission weight of 400 grams for grouping to an appropriate VIC-DRG4.
50
May be reproduced
Nasopharyngeal intubation
For 2000-2001, new 2nd edition procedure codes were introduced for
nasopharyngeal intubation (90179-02 Nasopharyngeal intubation and 90179-05
Management of nasopharyngeal intubation).
In AR-DRG Version 4.2, these codes are valid only for MDC 22 Burns. These codes
will be mapped to 92035-00 Other intubation of respiratory tract, so that episodes with
either of these codes will group to an appropriate VIC-DRG4.
Arteriovenous fistula
In AR-DRG Version 4.1, procedure codes for surgical formation of arteriovenous
fistula of lower limb (34509-00) and upper limb (34509-01), were not included in the
lists of procedures relevant to MDC 11 Diseases and disorders of kidney and urinary
tract. AR-DRG Version 4.2 has amended the allocation of procedure code 34509-01
arteriovenous anastomosis of upper limb but has not been amended for procedure code
34509-00 arteriovenous formation of lower limb. The procedure code for formation of
arteriovenous fistula in lower limb (34509-00) will be mapped to 34509-01
arteriovenous anastomosis of upper limb, for grouping to an appropriate VIC-DRG4.
May be reproduced
51
VAED Schedule Requirements 2001–2002
A hospital may transmit data via its nominated PRS/2 system as frequently as desired,
but must meet requirements set out below according to hospital type.
Public hospitals
The following will be included in the Victoria—Public Hospitals Policy and Funding
Guidelines 2001–2002 in Section B: Conditions of Funding: Acute Health.
Transmission of Admitted Patient Data.
The hospital will transmit data to the Victorian Admitted Episodes Dataset (VAED) via
PRS/2 according to the timelines detailed in clauses (a) and (b).
a) Admission and separation details for any month are to be transmitted in time for the
VAED file consolidation on the 21st day of the following month (see (d) below for
processing schedule).
b) Diagnosis and procedure and sub-acute details in any month are to be transmitted in
time for the VAED file consolidation on the 21st day of the second month following
(see (d) below for processing schedule).
c) Data for the financial year should be completed in time for the VAED file
consolidation on 21 August 2002.
Any corrections must be transmitted before
finalisation of the VAED database on 21 September 2002.
d) It is the hospital's responsibility to ensure that data are transmitted to the VAED to
meet the processing schedule for inclusion in the Allegiance Systems file consolidation
on the 21st of each month. Because of the various methods of transmission used by
hospitals, and Allegiance Systems’ processing schedules, data must be transmitted by
the PRS/2 feeder systems to the VAED by, at the latest, the 17th day of each month;
however, weekends or public holidays may bring the effective deadline forward to the
14th day.
52
May be reproduced
e) WIES9, multi-purpose services and sub-acute payments will be:
1) fully paid for data originally submitted in accordance with the deadlines
specified in clauses (a) and (b) above, even if data is subsequently
amended; or
2) paid at a reduced rate (50 percent), or not recognised for payment,
according to Schedules 2.1 and 2.2 located at the end of this section if the
data has not been submitted in accordance with either deadline specified in
clauses (a) and (b) above; or
3) not recognised for payment, if data has not been submitted in accordance
with both deadlines specified in clauses (a) and (b) above.
This clause applies to all account classes including DVA.
f) If difficulties are anticipated in meeting the relevant data transmission timeframes for
either admission and separation data, or diagnosis and procedure details, the hospital
or multi-purpose service must write to the Department, indicating the nature of the
difficulties, remedial action being taken, and the expected transmission schedule.
Exemptions for one-off late submission of data will generally only be considered for
computer system problems that are beyond the control of the hospital or multipurpose service. (Hospitals or multi-purpose services undertaking the PRS/2 data
submission testing process are automatically exempted.)
Exemptions for late
submission of admission and separation data will also be considered for staffing
problems that are beyond the control of the small rural hospitals or multi-purpose
services. Exemptions for late submission of admission and separation data will be
automatically granted to hospitals or multi-purpose services maintaining a
consistently high level of timely data submission.
g) Data should be reconciled after each transmission against the hospital or multipurpose service’s in-house computer or manual systems and against the Monthly
Return-Admitted Patients and any required corrections transmitted with data for the
subsequent period.
Private hospitals
Private hospitals are expected to adhere to the same timelines as Public hospitals
(indicated above).
May be reproduced
53
Schedule 2.1
Timelines for the Receipt of Admission and
Separations Details (E2)
VAED Consolidation Date
Month of Separation
2001/2002
July
21
Aug
Full
Rate
August
21
Sept
Half
Rate
Full
Rate
September
21
Oct
Nil
21
Nov
Nil
21
Dec
Nil
21
Jan
Nil
21
Feb
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Half
Rate
Full
Rate
Nil
October
November
December
January
Half
Rate
Full
Rate
Month of Separation
2001/2002
December
21
Mar
Nil
21
Apr
Nil
21
May
Nil
21
Jun
Nil
21
Jul
Nil
21
Aug
Nil
21
Sep
Nil
January
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Half
Rate
Nil
February
March
April
May
June
54
May be reproduced
Schedule 2.2
Timelines for the Receipt of Diagnoses and
Procedure (X2, Y2) and Sub-Acute Details (S2)
Month of Separation
2001/2002
July
21
Sept
Full
Rate
August
21
Oct
Half
Rate
Full
Rate
September
21
Nov
Nil
21
Dec
Nil
21
Jan
Nil
21
Feb
Nil
21
Mar
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Half
Rate
Full
Rate
Nil
October
November
December
Half
Rate
Month of Separation
2001/2002
December
January
February
March
April
May
June
May be reproduced
21
Mar
Half
Rate
Full
Rate
21
Apr
Nil
21
May
Nil
21
Jun
Nil
21
Jul
Nil
21
Aug
21
Sep
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Nil
Half
Rate
Full
Rate
Nil
Nil
Half
Rate
Full
Rate
Nil
Half
Rate
55
ICD-10-AM Library File for use in Victoria – 1.7.2001
As the move to AR-DRG v4.2 requires some revisions to the ICD Library File, the
opportunity has been taken to make a few other minor revisions. These are set out in the
table below.
Each hospital has two options:
•
Download the new ICD Library File that is available from the Department’s web site
(VAED downloadable files). This is password protected. Please contact the Help
Desk to obtain the password.
•
Make the changes listed in the table below to their existing ICD Library File.
Changes to ICD-10-AM Library File for use in Victoria for
separations on and after 1.7.2001
Key to this table
* Change [column] = the column of the Library File
§ Auth = Authority for change:
DRG
= revised in AR-DRG v4.2 (some edits in the Victorian file are more strict
than those specified in v4.2)
Vic
= Victorian decision
Code
Indication of Diagnosis Code Title
Change*
Specification
Auth§
I15.0
Renovascular hypertension
First [Age]
Insert
DRG
40015
I15.1
M35.2
Hypertension sec to other renal First [Age]
Insert
disorder
40015
Behcet’s disease
DRG
First [Age]
Remove edit
DRG
[Area]
Remove edit
Vic
N39.3
Stress incontinence
[Sex]
Remove edit
DRG
N99.0
Postprocedural renal failure
First [Age]
Insert
DRG
40015
N99.1
Postprocedural urethral stricture
First [Age]
Insert
DRG
40015
N99.4
Postproc pelvic adhesions
First [Age]
Insert
DRG
40015
56
May be reproduced
Code
Change*
Specification
Auth§
N99.5
Malfunction stoma
First [Age]
Insert
DRG
40015
N99.8
Other postproc GU system
First [Age]
Insert
DRG
40015
N99.9
Postproc GU NOS
First [Age]
Insert
DRG
40015
T31.00
Burns – body surface area
[Code]
Insert 1
DRG
T31.10
[Code]
Insert 1
DRG
T31.11
[Code]
Insert 1
DRG
T31.20
[Code]
Insert 1
DRG
T31.21
[Code]
Insert 1
DRG
T31.22
[Code]
Insert 1
DRG
T31.30
[Code]
Insert 1
DRG
T31.31
[Code]
Insert 1
DRG
T31.32
[Code]
Insert 1
DRG
T31.33
[Code]
Insert 1
DRG
T31.40
[Code]
Insert 1
DRG
T31.41
[Code]
Insert 1
DRG
T31.42
[Code]
Insert 1
DRG
T31.43
[Code]
Insert 1
DRG
T31.44
[Code]
Insert 1
DRG
T31.50
[Code]
Insert 1
DRG
T31.51
[Code]
Insert 1
DRG
T31.52
[Code]
Insert 1
DRG
T31.53
[Code]
Insert 1
DRG
T31.54
[Code]
Insert 1
DRG
T31.55
[Code]
Insert 1
DRG
T31.60
[Code]
Insert 1
DRG
T31.61
[Code]
Insert 1
DRG
T31.62
[Code]
Insert 1
DRG
T31.63
[Code]
Insert 1
DRG
T31.64
[Code]
Insert 1
DRG
T31.65
[Code]
Insert 1
DRG
T31.66
[Code]
Insert 1
DRG
T31.70
[Code]
Insert 1
DRG
T31.71
[Code]
Insert 1
DRG
T31.72
[Code]
Insert 1
DRG
May be reproduced
57
Code
Change*
Specification
Auth§
T31.73
[Code]
Insert 1
DRG
T31.74
[Code]
Insert 1
DRG
T31.75
[Code]
Insert 1
DRG
T31.76
[Code]
Insert 1
DRG
T31.77
[Code]
Insert 1
DRG
T31.80
[Code]
Insert 1
DRG
T31.81
[Code]
Insert 1
DRG
T31.82
[Code]
Insert 1
DRG
T31.83
[Code]
Insert 1
DRG
T31.84
[Code]
Insert 1
DRG
T31.85
[Code]
Insert 1
DRG
T31.86
[Code]
Insert 1
DRG
T31.87
[Code]
Insert 1
DRG
T31.88
[Code]
Insert 1
DRG
T31.90
[Code]
Insert 1
DRG
T31.91
[Code]
Insert 1
DRG
T31.92
[Code]
Insert 1
DRG
T31.93
[Code]
Insert 1
DRG
T31.94
[Code]
Insert 1
DRG
T31.95
[Code]
Insert 1
DRG
T31.96
[Code]
Insert 1
DRG
T31.97
[Code]
Insert 1
DRG
T31.98
[Code]
Insert 1
DRG
T31.99
[Code]
Insert 1
DRG
Z06
Infection w drug rest microorg.
[Code]
Insert 1
DRG
Z11.0
Spec screening
[Code]
Remove 1
DRG
Z11.1
Spec screening
[Code]
Remove 1
DRG
Z11.2
Spec screening
[Code]
Remove 1
DRG
Z11.3
Spec screening
[Code]
Remove 1
DRG
Z11.4
Spec screening
[Code]
Remove 1
DRG
Z11.5
Spec screening
[Code]
Remove 1
DRG
Z11.6
Spec screening
[Code]
Remove 1
DRG
Z11.8
Spec screening
[Code]
Remove 1
DRG
Z11.9
Spec screening
[Code]
Remove 1
DRG
Z12.0
Spec screening
[Code]
Remove 1
DRG
Z12.1
Spec screening
[Code]
Remove 1
DRG
Z12.2
Spec screening
[Code]
Remove 1
DRG
58
May be reproduced
Code
Change*
Specification
Auth§
Z12.3
Spec screening
[Code]
Remove 1
DRG
Z12.4
Spec screening
[Code]
Remove 1
DRG
Z12.5
Spec screening
[Code]
Remove 1
DRG
Z12.6
Spec screening
[Code]
Remove 1
DRG
Z12.8
Spec screening
[Code]
Remove 1
DRG
Z12.9
Spec screening
[Code]
Remove 1
DRG
Z13.0
Spec screening
[Code]
Remove 1
DRG
Z13.1
Spec screening
[Code]
Remove 1
DRG
Z13.2
Spec screening
[Code]
Remove 1
DRG
Z13.3
Spec screening
[Code]
Remove 1
DRG
Z13.4
Spec screening
[Code]
Remove 1
DRG
Z13.5
Spec screening
[Code]
Remove 1
DRG
Z13.6
Spec screening
[Code]
Remove 1
DRG
Z13.7
Spec screening
[Code]
Remove 1
DRG
Z13.81
Spec screening
[Code]
Remove 1
DRG
Z13.82
Spec screening
[Code]
Remove 1
DRG
Z13.83
Spec screening
[Code]
Remove 1
DRG
Z13.84
Spec screening
[Code]
Remove 1
DRG
Z13.85
Spec screening
[Code]
Remove 1
DRG
Z13.86
Spec screening
[Code]
Remove 1
DRG
Z13.88
Spec screening
[Code]
Remove 1
DRG
Z13.9
Spec screening
[Code]
Remove 1
DRG
Z30.5
IUD
First [Age]
Replace with
Vic
30011
Second [Age]
Replace with
41214
Z34.0
Z34.8
Z34.9
Supervision pregnancy
[Code]
[Code]
[Code]
Remove 1
DRG
Insert 2
Vic
Remove 1
DRG
Insert 2
Vic
Remove 1
DRG
Insert 2
Vic
Z35.0
[Code]
Remove 1
DRG
Z35.1
[Code]
Remove 1
DRG
Z35.2
[Code]
Remove 1
DRG
Z35.3
[Code]
Remove 1
DRG
Z35.4
[Code]
Remove 1
DRG
May be reproduced
59
Code
Change*
Specification
Auth§
Z35.5
[Code]
Remove 1
DRG
Z35.6
[Code]
Remove 1
DRG
Z35.7
[Code]
Remove 1
DRG
Z35.8
[Code]
Remove 1
DRG
Z35.9
[Code]
Remove 1
DRG
Insert 2
Vic
Z51.5
Palliative care
[Code]
Insert 1
DRG
Z76.1
Supervision healthy infant
[Code]
Remove 2
Vic
Z76.2
Supervision other healthy infant
[Code]
Remove 2
Vic
Z97.5
IUD
Second [Age]
Replace with
Vic
41214
Code
Indication of Procedure Code Title
Change*
Specification
Auth§
35506-01
Removal IUD
First [Age]
Change to
Vic
30011
Second [Age]
Change to
Vic
41214
45548-01
Removal breast tissue expander
[Sex]
Change to
Vic
4
NCCH Language of Health conference 2001
Several Victorian coders gave papers at the recent NCCH conference – did Victoria proud
– and DHS is particularly pleased they are all part of the Victorian Coding Committee.
Congratulations to:
•
Andrea Groom
•
Kylie Holcombe
•
Jennie Shepheard
•
Kathy Wilton
60
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Coding Standards Advisory Committee
Irene Kearsey, Department of Human Services
The Coding Standards Advisory Committee (CSAC) was established by the National
Centre for Classification in Health (then the National Coding Centre) in 1994. A
summary of how CSAC fits into the coding process could be useful to newer readers.
The Coding Standards Advisory Committee comprises representatives of the public and
private health sectors (a representative of each State/Territory health authority, one from
the Commonwealth authority and from the Australian Institute of Health and Welfare,
and one from the Australian Private Hospitals Association), the Health Information
Management Association of Australia Ltd and the Clinical Coders’ Society of Australia,
and a representative of the New Zealand health authority.
CSAC’s main function is to authorise the introduction of new and amended ICD-10-AM
codes and Australian Coding Standards (ACSs). However, CSAC also:
•
Advises on activities and products relating to coding and coding quality measures.
•
Reports to and from organisations and jurisdictions represented on the committee.
•
Ensures that standards of definition and convention are maintained when ratifying
changes to ICD-10-AM and the ACSs.
•
Reviews public submissions for changes to ICD-10-AM.
•
Receives feedback from users of coded data on the impact of standards and codes on
current data collections.
•
Ratifies coding advice from the NCCH before publication in Coding Matters.
•
Recommends future changes to the AR-DRG classification system, as they relate to
coding, to departments of health.
•
Recommends the national adoption of ICD-10-AM modifications on a biennial basis
to the National Health Information Management Group.
•
Provides input to relevant authorities on morbidity and mortality coding related
issues such as data edits, coding quality measurement, design or data collection
systems.
•
Provides coding advice on definitions related to relevant classification items in the
National Health Data Dictionary to the National Health Data Committee.
May be reproduced
61
•
Provides advice on the relationship between ACSs for morbidity coding and rules for
cause of death coding to NCCH and the Australian Bureau of Statistics.
•
Provides advice on other relevant health classification systems.
Apart from contributing to the revision process of the classification system, CSAC work
also flows into the education process and thus to all coders in Australia and New
Zealand.
Meetings are usually quarterly and (so far) have been held in the capital cities of the
eastern seaboard. Each meeting takes one (long) day but, between meetings, there is a
considerable amount of email traffic involving documents for comment. As Victoria’s
representative, I consult the Victorian ICD Coding Committee members for advice on my
response to CSAC issues and I report back to the Committee on the outcome of CSAC
meetings and decisions.
From a personal point of view, one valued outcome of CSAC is that we each get to know
our opposite numbers in the other health authorities and can contact them on non-coding
matters for information and advice. And, of course, the fact that we get to know NCCH
staff, and they get to know us, helps resolve issues.
As the Department of Human Services’ representative, I can observe how influential a
single coder can be in the development of ICD-10-AM: a submission to NCCH can
achieve a change if the problem is clearly described, any relevant information is
provided, and a clear solution is set out. Coders who find problems in the classification
should not think ‘I just have to put up with that’ – they should prepare a submission.
While NCCH has a set time for accepting submissions, your ideas should be worked up at
the time you find a problem, ready for submission. If you would like a sounding-board,
send draft submissions to the Victorian Coding Committee at any time for comment.
Because some problems can be fixed between editions of ICD-10-AM, send draft
submissions to the Committee at any time and we can forward it to NCCH immediately
if appropriate.
62
May be reproduced
Coding Calendar of Events
Date
Event
Details
29-31 July 2001
HIC 2001: Health Information
National Convention Centre,
and Health Informatics
Canberra
Conference
Discounted registration for HIMAA
members
www.hisa.org.au
17-19 August
Casemix Conference
2001
Singapore 2001 – A Journey
Begins
16-19 September
13th National Casemix
2001
Conference
March 2003
NCCH Biennial conference
Tan Tock Seng Hospital, Singapore
www.ttsh.gov.sg
Hobart, Tasmania
www.health.gov.au/casemix
Victoria
For a comprehensive list of health information events, see:
www.himaa.org.au/Calendar.html
May be reproduced
63
Victorian ICD Coding Committee
Member Profile – Evelyn Robinson
Brief Work History
After graduating in 1997 from Queensland University of Technology, my first position
was as a Regional Health Information Manager at Warrnambool Base Hospital. This
position included working at Camperdown and Timboon Hospitals.
Following this role, I was employed at Southern Health for approximately two years.
After leaving Southern, I worked at Cabrini for a brief period, before commencing my
current position as Coding Coordinator at Peninsula Health. In my ‘spare time’ I also
work one day a week at The Alfred Hospital.
Why did you join the Coding Committee?
I found I enjoyed coding and wanted to broaden my own experience and knowledge of
ICD coding through being a Committee member. I enjoy trying to solve coding queries,
researching difficult topics and helping others with coding problems, and felt I could
make a contribution as a Coding Committee member to assist other Victorian coders.
What do you see as the challenges for the Coding Committee in the
future?
To ensure queries are responded to in a timely manner. Endeavouring to keep up with
clinical advances in technology, in order to respond to coding queries. Developing and
maintaining an electronic format of Coding Committee queries.
64
May be reproduced
Name your most unusual possession
My husband Clive, who is a Furniture Designer, designed and made a very unusual wine
rack, which now takes pride of place in our home.
How do you cope with stress?
Stress + → Coffee
Stress +++ → Strong coffee
What is your most annoying habit?
I asked Clive this and he said there were far too many annoying habits to document
here!!
Finish this sentence: Never attempt to?
Say yes to completion of a ‘Member Profile’ article!
From your experience, what hints can you provide to Coders on achieving
and maintaining a high level of clinical coding competence?
Try to keep up as much as possible with reading all the relevant literature about coding
and clinical information. Also, regular liaison with clinicians can prove very useful in
improving clinical knowledge.
Family
Husband Clive. I also come from a large family, having seven sisters and numerous
nephews and nieces.
Interests
Football (Go Bombers!), Cricket and Rugby Union. I also enjoy travelling, both in
Australia and overseas, when I can find the time.
May be reproduced
65
Members as at 1 June 2001
Irene Kearsey
Convener (Department of Human Services)
Nicolette Thein
Secretary (Department of Human Services)
Sharon Brown
Latrobe Regional Hospital
Moira Cameron
Cabrini Hospital
Rhonda Carroll
The Alfred Hospital
Glenda Cunningham
Royal Talbot Rehabilitation Centre
Andrea Groom
Southern Health
Kylie Holcombe
St Vincent’s Hospital
Susan Peel
Yarra Ranges Health Service
Evelyn Robinson
Peninsula Health
Ruth Rundell
Barwon Health - The Geelong Hospital
Jennie Shepheard
La Trobe University representative
Kathy Wilton
Royal Children’s Hospital
Committee’s representative on VACCDI: Pauline Cripps, Box Hill Hospital
Next Meetings
Department of Human Services, 10.00 am, 555 Collins Street, Melbourne:
•
Tuesday 3 July 2001
•
Tuesday 7 August 2001
66
May be reproduced
On a Lighter Note
After discharging the last patient in the ER, I started for the sleep room at about 2am. The
nurse told me a moderately intoxicated man was coming in with a stuck contact lens. She
offered to take it out with a suction lens remover and have me sign the chart in the
morning. Half an hour later the ringing telephone at the bedside told me she hadn’t
succeeded.
Examination of the patient’s eyes produced an immediate explanation: Neither eye had a
contact lens in it. The patient had tried unsuccessfully to remove his cornea with his
fingernails, and the nurse had failed to improve the situation with the suction cup.
Unpersuaded by the facts, the patient repeatedly grasped his cornea between his thumb
and middle fingernails and pulled until his grip slipped off the tented membrane. Each
attempt produced the same exclamation, ‘Damn, that hurts. See I can get it out to here
but it always pops back.’
Finally, I asked to see his contact lens case. I showed him the lenses in his case and asked,
‘Whose lenses are these?’ Only then did he reluctantly admit he must have taken them
out and forgotten.
Two Tylenol 3’s got him through the night. A follow up exam the next day revealed
normal vision, healing corneal abrasions, a large subconjunctival haemorrhage, and an
ugly hangover.
May be reproduced
67
Alphabetic Index to Victorian
ICD-10-AM Coding Advice: July 1999 –
June 2001
ACS
Australian Coding Standard
CF
Coding Feature
CT
Coding Tip
HDSS # - MM/YY
HDSS Bulletin
Vic Addition
Victorian Additions to Australian Coding Standards
*Please refer to the original source for the page number of a query
Advice
Descriptor
Source
ID
-A#1485
Ablation, radiofrequency, liver
November 1999
#1572
Ablation, percutaneous transluminal myocardial septal
August 2000
#1612
Abscess, abdominal wall
November 2000
#1482
Abscess, submandibular, incision and drainage of
May 2000
#1494
Abstraction guidelines, general ACS 0010
February 2000
#1479
ACS 0002 Additional diagnoses
November 1999
Item 13.1
ACS 0002 Additional diagnoses (VAED)
HDSS 13 - 07/00
(replaces HDSS 2 - 07/99)
#1494
ACS 0010 General abstraction guidelines
February 2000
#1529
ACS 0012 Suspected Conditions
May 2000
#1689
ACS 0012 Suspected Condition (perforation)
June 2001
CF
ACS 0031 Anaesthetics
November 2000
#1659
ACS 0226 Prostatic Cancer
June 2001
#1468
ACS 0237 Recurrence of primary malignancy & 0234 February 2000
Contiguous sites & (NCCH query 884)
68
May be reproduced
Advice
Descriptor
Source
ACS 0909 Additional procedures performed in
June 2001
ID
#1691
conjunction with CABGs
#1622
ACS 1002 Asthma
June 2001
#1662
ACS 2103 Admission for convalesce/aftercare
June 2001
#1580
Acute pulmonary oedema
November 2000
#1479
Additional diagnoses, ACS 0002
November 1999
Item 13.1
Additional diagnoses, ACS 0002 (VAED)
HDSS 13 – 07/00
(replaces HDSS 2 - 07/99)
#1691
Additional procedures performed in conjunction with June 2001
CABGs, ACS 0909
#1507
Adjustment, ureteric memokath
February 2000
#1662
Admission for convalescence/aftercare, ACS 2103
June 2001
CF
Admissions principally for a specific treatment for February 2000
which there is a Z code
#1472
Alcohol dependence, past history
February 2000
#1564
Amplatzer duct occluder, insertion of
August 2000
#1520
Amputation and open fractures
May 2000
#1517
Amputation, distal 3rd and 4th fingers with
May 2000
reattachment
#1466
Anaemia, post operative
February 2000
CF
Anaesthesia, ACS 0031
November 2000
#1665
Anaesthetic procedures
June 2001
CF
Anaesthetics
June 2000
#1562
Angiograms, CT
August 2000
#1490
Apraxia, senile gait
May 2000
CF
Assigning code prefixes
June 2000
#1622
Asthma, ACS 1002
June 2001
#1654
Autologous Chondrocyte Implantation (ACI)
June 2001
-B#1470
Biopsy, transjugular liver
May be reproduced
May 2000
69
Descriptor
Source
CF
Blood transfusions
June 2000
#1499
Brachytherapy and radiotherapy
November 1999
#1480
Brachytherapy, intraluminal
November 1999
#1585
Brachytherapy, intra-coronary
August 2000
#1615
Breast lesion, wide local excision of
November 2000
#1568
Bypass using vein, ilio-femoral (PTFE)
August 2000
Advice
ID
-C#1478
Calciphylaxis
November 1999
CF
Cancelled surgery
June 2000
#1601
Cancer site codes
November 2000
#1558
Capsulectomy of shoulder
August 2000
#1571
Carbon fibre resurfacing
August 2000
#1589
Chemotherapy
November 2000
#1648
Chemotherapy and device loading
June 2001
Item 6.1
Chemotherapy - admission for
HDSS 6 -10/99
#1537
Chemotherapy cancelled due to URTI
August 2000
CF
Chemotherapy, intraperitoneal
August 1999
CF
Cochlear implant procedure
May 2000
CF
Coding idiosyncratic episodes
February 2000
CF
Coding of clinical information recorded by clinicians August 2000
other than medical officers
#1541
Coffin-Lowry syndrome
May 2000
#1636
Colonoscopy: investigation or finding
June 2001
#1532
Conscious state, decreased
May 2000
CF
Continuous ventilatory support
August 2000
0029
Contracted procedures, coding of
Vic Addition
#1624
COAD and pneumonia, sequencing of
November 2000
#1538
COPD, infective exacerbation of, with emphysema
May 2000
#1492
Coronary artery disease in stent and transplanted heart
November 1999
70
May be reproduced
Descriptor
Source
#1510
Coroner’s report/Post mortem coding
February 2000
#1562
CT Angiograms
August 2000
#1613
Cyst, mullerian
November 2000
#1515
Cystadenoma of ovary (borderline malignancy)
February 2000
Advice
ID
-D#1532
Decreased conscious state
May 2000
#1472
Dependence, alcohol, past history
February 2000
#1618
Dependence, opioid
November 2000
#1551
Dependency, benzhexol
May 2000
#1513
Depression, postnatal
February 2000
CF
Diabetes
November 2000
#1597
Diabetes – periungual telangiectasia
November 2000
CT
Diabetes with diarrhoea
November
2000
(replaces CF June 2000)
CF
Diabetes with multiple complications
August 1999
#1548
Diastasis recti post delivery
May 2000
#1539
Diathermy of penile wart
May 2000
#1566
Dimple, sacral
May 2000
#1542
Disorder, schizoaffective, hypomanic
May 2000
#1625
Drainage, cyst, liver, ultrasound guided (percutaneous)
November 2000
#1484
Dysplasia, Otospondylomegaepiphyseal
August 2000
-E#1538
Emphysema with infective exacerbation of COPD
May 2000
#1593
Epidural during labour
November 2000
#1555
Epilepsy and status epilepticus
August 2000
#1685
Ethanol injection
June 2001
#1560
Excision/removal of osteophytes
August 2000
#1615
Excision, wide local, breast lesion
November 2000
#1584
Excision, wide, of neoplasm
August 2000
May be reproduced
71
Advice
Descriptor
Source
External cause code - Scooters
June 2001
ID
#1669
-F#1676
Follow-up gastroscopy
June 2001
#1520
Fractures, open and amputation
May 2000
#1540
Fundoplication, Nissen (laparoscopic), revision of
May 2000
-G#1489
GAMP (ACS 1912 Sequelae of injuries, poisonings, toxic November 1999
effects and other external causes and 1906 Current and old
injuries)
#1530
Gastric lap bands
November 2000
#1462
Geriatric Evaluation and Management Program coding
November 1999
#1501
Group B strep. status, (unknown)
February 2000
#1563
Group B strep. carrier in pregnancy
August 2000
#1677
Grouping of laparoscopy codes
June 2001
-H#1578
Hemicolectomy and LUSCS
August 2000
#1599
Hepatic portal vein pressure/post pressure studies
November 2000
#1582
Hepatitis B vaccinations in newborns
August 2000
#1573
Hepatitis B vaccine
August 2000
#1609
Hernia, ventral or epigastric
November 2000
#1623
Hysterectomy, vaginal, laparoscopically assisted
November 2000
-I#1621
I24.0, use of code
November 2000
#1568
Ilio-femoral bypass using vein (PTFE)
August 2000
#1500
Impacted tooth, surgical removal
November 1999
#1476
Implant, breast, re-inflation of
May 2000
CF
Implant, cochlear
May 2000
#1546
Implant, facial, removal of
November 2000
#1569
Implant, iridium, insertion of
August 2000
72
May be reproduced
Descriptor
Source
#1495
Implant, loop recorder
February 2000
#1552
Implant, nose (silicon), removal of
May 2000
#1579
Implant, silastic, thyroplasty
August 2000
#1482
Incision and drainage of submandibular abscess
May 2000
CF
Infusion, isolated limb
November 1999
#1565
Infusion pump for pain management
August 2000
#1564
Insertion of amplatzer duct occluder
August 2000
#1569
Insertion of iridium implant
August 2000
#1598
Insertion of pleuroperitoneal shunt
November 2000
#1567
Insertion, transfemoral aortic stent
August 2000
#1585
Intra-coronary brachytherapy
August 2000
CF
Intraocular lens guide
November
Advice
ID
2000
(replaces CF August 2000)
#1575
Intravascular ultrasound
August 2000
-L#1475
Lacerated bowel and bladder during LUSCS
May 2000
#1651
Laparoscopic cholecystectomy to open cholecystectomy June 2001
with exploration of CBD
#1677
Laparoscopy codes, grouping of
June 2001
#1504
Lavage, arthroscopic, of shoulder
February 2000
#1493
LeFort Osteotomy
November 1999
#1615
Lesion, breast, wide local excision of
November 2000
#1638
Low birthweight
June 2001
#1680
Low K+
June 2001
#1578
LUSCS and hemicolectomy
August 2000
-M#1600
Meconium in liquor
November 2000
#1644
Mechanical complication of ventricular shunt
June 2001
#1543
Melanotic macule, lip-labial
May 2000
May be reproduced
73
Descriptor
Source
#1587
Mesocaval shunt, thrombectomy of
August 2000
#1545
Metastatic spread
May 2000
CF
Minor Trauma Coding
June 2001
0233
Morphology
Vic Addition
#1664
Musculoskeletal chest pain
June 2001
#1473
Myelodysplastic syndrome with anaemia
November 1999
Advice
ID
-N#1584
Neoplasm, wide excision of
August 2000
#1540
Nissen fundoplication, laparoscopic, revision of
May 2000
-O#1661
Obstetrics, principal diagnosis
June 2001
#1519
Obstruction, upper airway
February 2000
#1580
Oedema, acute pulmonary
November 2000
#1618
Opioid dependence
November 2000
0030
Organ procurement
Vic Addition
#1671
Osseous metaplasia and solar lentigo
June 2001
#1560
Osteophytes, excision/removal of
August 2000
#1693
Osteotomies with internal fixation (bilateral maxilla and June 2001
mandible)
#1484
Otospondylomegaepiphyseal dysplasia
August 2000
#1496
Overwarfarinisation/stabilisation of INR
February 2000
-P#1620
Pacemaker recall
November 2000
#1663
Palliative Care
June 2001
#1572
Percutaneous transluminal myocardial septal ablation
August 2000
#1597
Periungual telangiectasia in diabetes
November 2000
#1486
Photodynamic therapy (PDT)
May 2000
CF
Place of occurrence
June 2000
#1598
Pleuroperitoneal shunt insertion
November 2000
74
May be reproduced
Descriptor
Source
#1624
Pneumonia and COAD, sequencing of
November 2000
CF
Poisoning and adverse effects of drugs
August 2000
#1642
Post infarction angina
June 2001
#1650
Post-procedural complications
June 2001
#1510
Post mortem/Coroner’s report coding
February 2000
#1527
Pre-admission tests
May 2000
CF
Prefixes, assignment of
June 2000
Prefix.1
Prefixes for diagnoses
Vic Addition
Prefix.2
Prefixes for obstetric codes
Vic Addition
#1583
Pregnancy following tubal ligation
August 2000
#1561
Premature labour, patient transferred to another hospital November 2000
#1661
Principal diagnosis in Obstetrics
June 2001
#1628
Principal procedure selection
November 2000
#1659
Prostatic Cancer, ACS 0226
June 2001
#1568
PTFE (ilio-femoral bypass using vein)
August 2000
#1599
Pressure/portal pressure studies, hepatic portal vein
November 2000
#1580
Pulmonary oedema, acute
November 2000
Advice
ID
-R#1485
Radiofrequency ablation of liver
November 1999
0229
Radiotherapy
Vic Addition
#1499
Radiotherapy and brachytherapy
November 1999
#1518
Reattachment of finger
February 2000
#1517
Reattachment, amputated distal 3rd and 4th fingers
May 2000
#1468
Recurrence of primary malignancy (ACS 0237) & 0234 February 2000
Contiguous sites & (NCCH query 884)
2104
Rehabilitation
Vic Addition
#1476
Re-inflation of breast implant
May 2000
#1552
Removal of silicon implant from nose
May 2000
#1535
Removal, bath drain from fingers
May 2000
May be reproduced
75
Descriptor
Source
#1560
Removal/excision of osteophytes
August 2000
#1546
Removal, facial implants
November 2000
#1511
Repair AAA with endoluminal bifurcation graft
February 2000
#1516
Replacement of progesterone ‘IUD’
February 2000
#1571
Resurfacing, carbon fibre
August 2000
#1641
Retained products of conception
June 2001
#1540
Revision of a laparoscopic Nissen Fundoplication
May 2000
Advice
ID
-S#1542
Schizoaffective disorder, hypomanic
May 2000
#1544
Schizophrenia, chronic
May 2000
#1669
Scooters - External cause code
June 2001
CF
Screening for specific disorders
August 2000
#1628
Selection principal procedure
November 2000
CF
Sequencing guidelines
June 2000
#1624
Sequencing of COAD and pneumonia
November 2000
#1587
Shunt, mesocaval, thrombectomy of
August 2000
#1598
Shunt, pleuroperitoneal, insertion of
November 2000
#1579
Silastic implant thyroplasty
August 2000
#1658
Smoking related COPD
June 2001
#1671
Solar lentigo and osseous metaplasia
June 2001
#1555
Status epilepticus and epilepsy
August 2000
#1487
Stenosis, lumbar spinal
November 1999
#1506
Stent, endobronchial
February 2000
#1567
Stent, transfemoral aortic, insertion of
August 2000
#1465
Sternal wires
May 2000
#1501
Strep. Group B status, (unknown)
February 2000
#1563
Strep. Group B carrier in pregnancy
August 2000
#1599
Studies, pressure/portal pressure, hepatic protal vein
November 2000
#1559
Study, WADA
August 2000
76
May be reproduced
Descriptor
Source
#1463
Sudden cardiac death
November 1999
#1529
Suspected conditions, ACS 0012
May 2000
#1689
Suspected condition (perforation), ACS 0012
June 2001
#1541
Syndrome, Coffin-Lowry
May 2000
Advice
ID
-T#1553
Tamoxifen for breast cancer
May 2000
#1597
Telangiectasia, periungual in diabetes
November 2000
#1527
Tests, pre-admission
May 2000
#1486
Therapy, photodynamic
May 2000
#1587
Thrombectomy of mesocaval shunt
August 2000
#1503
Thrombophlebitis, post operative
February 2000
#1579
Thyroplasty, silastic implant
August 2000
CF
Tracheostomy
June 2000
CF
Transfusions, blood
June 2000
#1470
Transjugular liver biopsy
May 2000
-U#1625
Ultrasound guided percutaneous drainage liver cyst
November 2000
#1575
Ultrasound, intravascular
August 2000
Item 14.3
Unacceptable obstetric diagnosis combination
HDSS 14 – 07/00
(replaces CF June 2000)
#1682
Underlying condition
June 2001
#1501
Unknown Group B. strep status
February 2000
-V#1582
Vaccination, Hepatitis B in newborns
August 2000
#1573
Vaccine, Hepatitis B
August 2000
CF
Ventilatory support, continuous
August 2000
0029
VIC Addition - Coding of contracted procedures
Vic Addition
0233
VIC Addition - Morphology
Vic Addition
0030
VIC Addition - Organ procurement
Vic Addition
May be reproduced
77
Descriptor
Source
Prefix.1
VIC Addition - Prefixes for diagnoses
Vic Addition
Prefix.2
VIC Addition - Prefixes for obstetric codes
Vic Addition
0229
VIC Addition - Radiotherapy
Vic Addition
2104
VIC Addition - Rehabilitation
Vic Addition
Advice
ID
-W#1559
WADA study
August 2000
#1539
Wart, penile, diathermy of
May 2000
#1471
Warts, vulval, vaginal and perianal warts
May 2000
#1584
Wide excision of neoplasm
August 2000
-X#1576
Xanthelasma
August 2000
-ZCF
78
Z codes – Admissions principally for a specific treatment February 2000
May be reproduced
Abbreviations
ACS
Australian Coding Standard
ADX
Additional Diagnosis
AN-DRG
Australian National Diagnosis Related Groups
AR-DRG
Australian Refined Diagnosis Related Groups
CABG
Coronary Artery Bypass Graft
D&C
Dilation and Curettage
DHS
Department of Human Services
GA
General Anaesthetic
HDSS
Health Data Standards and Systems
HIMAA
Health Information Management Association of Australia
HMA
Healthcare Management Advisors Pty Ltd
ICD-9-CM
International Classification of Diseases - 9th Revision – Clinical
Modification
ICD-10-AM
Statistical Classification of Diseases and Related Health Problems, 10th
Revision, Australian Modification
LUSCS
Lower Uterine Segment Caesarean Section
NCCH
National Centre for Classification in Health
RPOC
Retained Products of Conception
TOE
Transoesophageal Echocardiogram
VAED
Victorian Admitted Episodes Dataset
VEMD
Victorian Emergency Minimum Dataset
VICC
Victorian ICD Coding Committee
May be reproduced
79

ICD Coding Newsletter June 2001 Distribution List

Transcription

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