Coding Rules
ACCD Classification Information Portal
Ref No: Q2659 | Published On: 15-Dec-2013 | Status: Current
Skin Necrosis
Q:
Should skin necrosis be coded the same as gangrene? When there is documentation of necrotic ulcer should both R02
and L97 be assigned and if yes, in what order?
A:
ICD-10-AM classifies skin necrosis without further specification to R02 Gangrene NEC as per ICD-10. The above query
does not specifically mention the wound site, but as L97 Ulcer of lower limb is cited, the NCCH assumes the query
relates to a lower limb necrotic/gangrenous ulcer.
When an ulcer is described as necrotic, gangrenous or with areas of skin necrosis it is appropriate to assign a code for
the ulcer (L97 in the case of lower limb ulcers) and R02 (except for pressure areas where necrosis is inherent in the
staging) even though L97 excludes R02 Gangrene (i.e. skin necrosis).
Code sequencing is determined by following the principles in ACS 0001 Principal diagnosis and ACS 0002 Additional
diagnoses (see also ACS 1802 Signs and symptoms).
(Coding Rules, December 2013)
Ref No: Q2679 | Published On: 15-Dec-2013 | Status: Current
Coronary Optical Coherence Tomography (OCT) and
Intravascular ultrasound (IVUS)
Q:
What codes should be assigned for Coronary OCT and IVUS?
A:
Coronary Optical Coherence Tomography (OCT) is a catheter based invasive imaging system that uses near infra-red light
providing a high resolution image in vivo of the coronary arteries. This technology enables the extent of atherosclerosis
to be seen within the artery and is being used to check previously implanted stents as some patients, like diabetics, are
predisposed to re- stenosis of the stent.
Intravascular ultrasound (IVUS) is a catheter based invasive imaging system that uses sound waves to provide an image
of the coronary artery walls and plaque deposits.
Both of these techniques are increasingly being used in percutaneous coronary interventions due to the detail of the
images they are able to provide over the more traditional coronary angiograms.
There are no procedure codes in ACHI to distinguish these techniques, however as they are both catheter based imaging
techniques used on coronary arteries, they should be classified to [668] Coronary angiography following either the lead
term Catheterisation or Angiography.
Consideration will be given to incorporating these techniques within block [668] Coronary angiography for a future
edition of ACHI.
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2705 | Published On: 15-Dec-2013 | Status: Current
Acquired Oesophageal Dysmotility
Q:
How do you code oesophageal dysmotility that is acquired?
A:
ICD-10-AM has the following index entry for dysmotility of the oesophagus:
Dysmotility, oesophagus, congenital Q39.82
There is currently no index entry for acquired oesophageal dysmotility.
Oesophageal dysmotility is synonymous with oesophageal dyskinesia classifiable to K22.4 Dyskinesia of oesophagus.
Therefore, acquired dysmotility of the oesophagus should be assigned K22.4.
The NCCH will consider improvements to the ICD-10-AM Alphabetic Index for this condition in a future edition.
(Coding Rules, December 2013)
Ref No: Q2753 | Published On: 15-Dec-2013 | Status: Current
T-incision (or J-incision) caesarean section
Q:
How do you code a T-incision (or J-incision) caesarean section?
A:
An inverted T-incision (or J-incision) caesarean section is a rarely performed type of caesarean section. These types of
incisions incorporate both a horizontal and vertical incision and are associated with increased risk and complications,
similar to those that occur with a classical caesarean section.
Where T-incision (or J-incision) caesarean section is documented, assign an appropriate code for classical caesarean
section:
16520-00 [1340] Elective classical caesarean section
16520-01 [1340] Emergency classical caesarean section
The NCCH will consider amendments to the Alphabetic Index for a future edition.
(Coding Rules, December 2013)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2761 | Published On: 15-Dec-2013 | Status: Current
Pancytopenia
Q:
Where there is documentation of pancytopenia and one or two of the blood abnormalities in the clinical record, is a
code assigned for each of the specific blood abnormalities as well as the pancytopenia code?
A:
Pancytopenia is not a disease entity itself but a term describing a triad of simultaneous findings - anaemia,
leukocytopenia/leukopenia/neutropenia and thrombocytopenia (see ACS 0304 Pancytopenia).
Where pancytopenia is documented in conjunction with any or all of the triad of blood abnormalities listed above,
assign codes for the specific blood abnormalities only. It is not necessary to assign an additional code for the general
term pancytopenia.
NCCH will consider improvements to the classification for pancytopenia for a future edition of ICD-10-AM.
(Coding Rules, December 2013)
Ref No: Q2775 | Published On: 15-Dec-2013 | Status: Current
Renal sclerosis and nephrosclerosis
Q:
What is the difference between nephrosclerosis and renal sclerosis?
The index assigns nephrosclerosis to I12.9 Hypertensive kidney disease without kidney failure. Does a causal
relationship between nephrosclerosis and hypertension need to be documented in order to assign I12.-?
A:
Clinical advice indicates that nephrosclerosis is not synonymous with renal sclerosis and they should be classified
separately in ICD-10-AM.
Renal sclerosis is a rarely used term, referring to scarring or shrinkage of the whole kidney or where scars are at least
visible in parts of the kidney macroscopically.
Nephrosclerosis by contrast is a term commonly used to describe the scarring changes in the glomeruli (tiny blood
vessels in the kidney) and interstitium of the kidney, as seen under a microscope. ICD-10 defaults the classification
of nephrosclerosis to I12.9 Hypertensive kidney disease without kidney failure. Clinical advice indicated that while
not all cases of nephrosclerosis are caused by hypertension, the condition fits best within I12.- as in
nephrosclerosis both hypertension and chronic kidney disease are usually present with no other recognisable
cause. Therefore, for nephrosclerosis assign I12.0 Hypertensive kidney disease with kidney failure or I12.9
Hypertensive kidney disease without kidney failure, as appropriate.
Indexing improvements for nephrosclerosis will be considered for a future edition of ICD-10-AM.
ICD-10-AM classifies renal sclerosis to N26 Unspecified contracted kidney but there is a note at N26 which excludes
“contracted kidney due to hypertension (112.-).” A code from I12.- should only be assigned if renal sclerosis is clearly
documented as being due to hypertension.
Bibliography:
Rule., A.D., Cornell., L.D., Poggio., E.D.(2011). Senile Nephrosclerosis – Does it explain the decline in glomerular filtration rate with aging? Nephron Physiol, 119 (suppl 1),
pages 6-11. Doi.org/10.1159/000328012
Marín., R., Gorostidi., M., Ojea. B.D. (2010). Nephrosclerosis. The Cinderella of chronic kidney disease. Nefrologia, 30(3), pages 275-279. Doi.
10.3265/Nefrologia.pre2010.Apr.10329
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2787 | Published On: 15-Dec-2013 | Status: Current
Microfracture of the ankle
Q:
What is the appropriate code for microfracture of the ankle?
A:
Microfracture involves penetration of bone at the base of a cartilage defect. This causes formation of a “superclot” in
the base of the lesion. The theory behind this treatment is that the superclot contains factors and cells which allow
cartilage regeneration. The area of cartilage damage is debrided and an “awl” (or arthroscopic pick) is used to produce
hole(s) in the bone at the base of the defect (see Coding Matters, Volume 11, Number 4).
The appropriate code to assign for microfracture of the ankle is 49703-05 [1544] Arthroscopic chondroplasty of ankle
by following the index pathway:
Chondroplasty
- ankle 90599-00 [1544]
- - arthroscopic 49703-05 [1544]
The NCCH will consider index entries for microfracture for a future edition of ACHI.
(Coding Rules, December 2013)
Ref No: Q2807 | Published On: 15-Dec-2013 | Status: Current
Impaired Mobility
Q:
How do you code impaired mobility when there is no underlying cause documented?
A:
The NCCH advises that impaired/reduced mobility should be classified to R26.8 Other and unspecified abnormalities
of gait and mobility.
Z74.0 Need for assistance due to reduced mobility is not a viable option for classifying impaired/reduced mobility.
Codes from Chapter 21 Factors influencing health status and contact with health services (Z00-Z99) are assigned when
there is not an appropriate disease code available in Chapters 1-20 as per the note at the beginning of Chapter 21:
Note: Categories Z00–Z99 are provided for occasions when circumstances other than a disease, injury or
external cause classifiable to categories A00–Y89 are recorded as ‘diagnoses’ or ‘problems’.
The indexing of R26.8, based on ICD-10, is not optimal and NCCH will consider amendments for a future edition of ICD10-AM. (see also ACS 1802 Signs and Symptoms)
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2810 | Published On: 15-Dec-2013 | Status: Current
Balloon catheter induction of labour
Q:
What is the correct code assignment for balloon catheter induction of labour without documentation of surgical
induction?
A:
The Alphabetic Index of Interventions requires you to determine whether an induction is medical or surgical before you
select the specific type of induction. Medical induction of labour is a pharmacological method, commonly using drugs
such as Syntocinon, Prostin or Cervagem. Surgical induction of labour uses non-pharmacological methods, such as
artificial rupture of membranes and insertion of balloon catheters.
Balloon catheters are used to apply local pressure to dilate the cervix and overstretch the lower uterine segment,
indirectly stimulating the secretion of prostaglandins. This is commonly done using a Foley catheter; however
variations such as a double balloon catheter are also in use.
The correct code for balloon catheter induction of labour, without medical induction, is 90465-04 [1334] Other surgical
induction of labour, following the index pathway:
Induction
- labour
- - surgical 90465-03 [1334]
- - - by
- - - - cervical dilation 90465-04 [1334]
Bibliography:
Eke, A., & Okigbo C. (2012). Mechanical methods for induction of labour: RHL commentary. Retrieved from the WHO Reproductive Health Library website:
http://apps.who.int/rhl/pregnancy_childbirth/induction/cd001233_ekea_com/en/index.html
Pennell, C., Henderson, J., O’Neill, M., McCleery, S., Doherty, D.& Dickinson, J. (2009). Induction of labour in nulliparous women with an unfavourable cervix: a randomised
controlled trial comparing double and single balloon catheters and PGE2 gel. BJOG: An International Journal of Obstetrics & Gynaecology, 116, 1443–1452. doi: 10.1111/j.1471
-0528.2009.02279.x
(Coding Rules, December 2013)
Ref No: Q2815 | Published On: 15-Dec-2013 | Status: Current
Use of Z30.1 Insertion of contraceptive device
Q:
Is it necessary to assign Z30.1 Insertion of contraceptive device in any episode where a patient has a subdermal
contraceptive implant inserted in addition to another procedure?
A:
It is correct to assign Z30.1 Insertion of contraceptive device, in addition to the procedure code 14203-00 [1906] Direct
subdermal hormone implantation, when a subdermal hormone implant is inserted for the purpose of contraception.
Similarly, Z30.1 is always assigned for insertion of intrauterine contraceptive device, in addition to the procedure code,
when the intention is for contraceptive management.
This is consistent with previously published advice regarding the assignment of Z30.2 Sterilisation (See Coding Q&A,
Diagnosis code for sterilisation when performed in conjunction with other procedures, December 2012).
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2813 | Published On: 15-Dec-2013 | Status: Current
Donor Lymphocyte Infusion
Q:
Is a donor lymphocyte infusion considered a stem cell transplant or is it a transfusion of a blood product?
A:
Donor lymphocyte infusion (DLI) is the administration of donated lymphocytes to patients who have previously
received stem cell transplantation and have either residual disease or relapse of their leukaemia, lymphoma or
myeloma. The donor lymphocytes recognise the patient’s cells as foreign and attack them, causing a condition called
graft versus host disease (GvHD). The benefit of this immune response is that the donor cells also kill any leukaemia
cells present.
DLI is classified as 13706-04 [1893] Administration of leukocytes by following the index pathways:
Administration
- donor leukocytes 13706-04 [1893]
Infusion
- leukocytes (donor) 13706-04 [1893]
All previous advice regarding DLI is superseded by this response.
(Coding Rules, December 2013)
Ref No: Q2822 | Published On: 15-Dec-2013 | Status: Current
Portal Vein Thrombosis
Q:
How do you code a single portal vein thrombus extending into additional vessels, for example – Abdo CT states
that the thrombus has extended into the splenic vein at its junction with the portal vein and also into the superior
mesenteric artery.
A:
Portal vein thrombosis (PVT) is defined as thrombosis of the portal vein and/or its tributaries, which include the splenic
vein and the superior and inferior mesenteric veins. Splenic vein thrombosis may occur with a patent portal vein.
Thrombosis of the mesenteric veins without involvement of the portal vein is uncommon.
For the scenario cited, documentation of portal vein thrombosis, assign I81 Portal vein thrombosis. Additional codes
should not be assigned to identify the thrombosis of the splenic vein or superior mesenteric vessel as this is part of the
PVT.
The NCCH will consider amendments to ICD-10-AM for a future edition.
References:
Boyer, T. (2008). Management of Portal Vein Thrombosis. Gastroenterology and hepatology (N Y) October; 4(10): 699–700. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104181/
(Coding Rules, December 2013)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2832 | Published On: 15-Dec-2013 | Status: Current
Haemolung (Respiratory Assist System)
Q:
Our hospital has been approved to perform a procedure not yet used in Australia called Haemolung. How should we
code this procedure?
A:
Haemolung (respiratory assist system) is the brand name of a respiratory dialysis device that provides extracorporeal
gas exchange to a patient’s blood. It is similar to extracorporeal membrane oxygenation, but this device removes
carbon dioxide as well as adding oxygen to the blood.
Blood is diverted from either the femoral or jugular veins via a double lumen venous catheter. Deoxygenated blood
drains from the body into the device. Carbon dioxide is removed and the blood is oxygenated across a membrane
containing heparin to prevent thrombus formation. The oxygenated blood returns to the body via a centrifugal pump.
Use of the device is still being trialled.
NCCH advises that Haemolung (respiratory assist system)/respiratory dialysis should be classified to 90225-00 [642]
Extracorporeal membrane oxygenation [ECMO] given its similarity to this procedure.
(Coding Rules, December 2013)
Ref No: Q2829 | Published On: 15-Dec-2013 | Status: Current
Removal of silicone oil from eye post retinal
detachment repair
Q:
What is the correct principal diagnosis for a patient admitted for removal of silicone oil post retinal detachment repair?
A:
Assign Z48.8 Other specified surgical follow-up care by following the index pathway:
Aftercare (see also Care)
- following surgery
- - specified NEC Z48.8
This is consistent with the classification of admissions for removal of arteriovenous shunt or for removal of
nasolacrimal tube where Z48.8 Other specified surgical follow-up care is assigned as per the ICD-10-AM Alphabetic
Index.
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2824 | Published On: 15-Dec-2013 | Status: Current
Selective Internal Radiation Therapy (SIRT) into the
liver
Q:
What is the correct procedure code to assign for Selective Internal Radiation Therapy (SIRT) into the liver?
A:
Selective internal radiation therapy (SIRT), also known as radio-embolisation, is a type of microbrachytherapy used to
treat unresectable liver cancer. The procedure is typically perfomed in two stages. At the initial work up stage,
radiographic imaging and prophylactic occlusion of gastric, gastro-duodenal or pancreatic arteries by selective coil are
performed to prevent severe radiation damage to the foregut structures such as stomach, duodenum and pancreas.
The second stage (treatment stage) involves infusing millions of radioactive beads (Yttrium 90 resin microspheres)
directly into the arterial blood supply of the liver through either a surgically implanted port or a percutaneous
transfemoral hepatic artery catheter. These microspheres embolise the arterioles around the malignancy and also emit
radiation to destroy the cancerous cells.
For the initial workup stage, the correct procedure code to assign is:
35321-05 [768] Transcatheter embolisation of blood vessels, abdomen
For the treatment stage, the correct codes to assign are:
35321-05 [768] Transcatheter embolisation of blood vessels, abdomen
and
15360-00 [1792] Brachytherapy, intravascular
Consideration will be given to improving the index for intravascular brachytherapy for a future edition of ACHI.
Bibliography:
National Institute for Health and Care Excellence (2013). Selective internal radiation therapy for primary liver cancer. Retrieved
from: http://guidance.nice.org.uk/IPG460/DraftGuidance
SIRTeX (n.d.). About SIRT. Retrieved from: http://www.sirtex.com/au/clinicians/about-sirt/
Stubbs, R.S., Wickremesekera, S.K.(2004). Selective internal radiation therapy (SIRT): a new modality for treating patients with colorectal liver metastases. HPB (Oxford),
6(3), Pages133–139. doi: 10.1080/13651820410025084
Welsh, J., Kennedy, A., Thomadsen, B. (2006). Selective internal radiation therapy (SIRT) for liver metastases secondary to colorectal adenocarcinoma. International Journal of
Radiation Oncology*Biology*Physics, 66(2), Supplement, Pages S62–S73. Doi: 10.1016/j.ijrobp.2005.09.011
(Coding Rules, December 2013)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2833 | Published On: 15-Dec-2013 | Status: Current
Insertion of fiducial markers into the gastrooesophageal junction
Q:
What is the correct procedure code to assign for insertion of fiducial markers into the gastro-oesophageal junction?
A:
Fiducial markers are inserted into target lesions or soft tissue as landmarks for precise delivery of radiation therapy.
Traditionally, fiducial markers have been implanted into the prostate, lungs and spine via a percutaneous or surgical
approach under image guidance. Recent advances have led to fiducial markers being placed into target lesions in deep
structures that are not accessible by a percutaneous approach, such as the gastrointestinal tract, mediastinum and
abdomen, using endoscopic ultrasound (EUS) guidance.
ACHI currently only has specific codes for insertion of fiducial markers into the prostate. Classification of fiducial
markers for other sites will be reviewed for a future edition of ACHI.
In the interim, insertion of fiducial markers in any location other than the prostate or lung should be assigned to an
appropriate site code for ‘other procedures.’ Additional code(s) should also be assigned where EUS or laparoscopy is
performed in conjunction with fiducial marker placement.
For insertion of fiducial markers into the gastro-oesophageal junction, assign:
90305-00 [890] Other procedures on stomach and
30688-00 [1949] Endoscopic ultrasound
For insertion of fiducial markers into the prostate, assign:
37217-00 [1160] Implantation of fiducial marker, prostate
For insertion of fiducial markers into the lung, assign:
38812-00 [550] Percutaneous needle biopsy of lung
See also Coding Q&A, June 2013, Insertion of fiducial markers into the lung percutaneously.
References:
DiMaio, C., Nagula, S., Karyn A. Goodman, K., Alice Y. Ho, A., Markowitz, A., Schattner, M., Gerdes,H. (2010). EUS-guided fiducial placement for image-guided radiation therapy
in GI malignancies by using a 22-gauge needle. Gastrointestinal Endoscopy, 71(7), 1204–1210. doi:10.1016/j.gie.2010.01.003
Pishvaian, A.C., Collins,B., Gagnon,G., Ahlawat, S.,Haddad, N.G. (2006). EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies.
Gastrointestinal Endoscopy, 64, 412–417. doi:10.1016/j.gie.2006.01.048
(Coding Rules, December 2013)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2835 | Published On: 15-Dec-2013 | Status: Current
Type 2 diabetes mellitus with hypercholesterolaemia
or hyperlipidaemia
Q:
When hypercholesterolaemia and hyperlipidaemia meet the criteria in ACS 0002 should E78.0 Pure
hypercholesterolaemia or E78.5 Hyperlipidaemia, unspecified be assigned in addition to elevated fasting triglycerides
(E78.1 Pure hyperglyceridaemia) or depressed HDLs (E78.6 Lipoprotein deficiency) in a Type 2 diabetes mellitus patient
with features of insulin resistance?
A:
The codes at category E78 Disorders of lipoprotein metabolism and other lipidaemias are not mutually exclusive and there
are no index entries to preclude the assignment of E78.0 Pure hypercholesterolaemia and E78.5 Hyperlipidaemia,
unspecified in addition to E78.1 Pure hyperglyceridaemia and E78.6 Lipoprotein deficiency.
For Type 2 diabetes mellitus patient with features of insulin resistance, assign E78.0 Pure hypercholesterolaemia or
E78.5 Hyperlipidaemia, unspecified in addition to E78.1 Pure hyperglyceridaemia and E78.6 Lipoprotein deficiency if
these conditions meet the criteria in ACS 0002 Additional diagnoses.
(Coding Rules, December 2013)
Current as at 16-Dec-2013 06:38
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