Coding Rules
ACCD Classification Information Portal
Ref No: Q2642 | Published On: 15-Mar-2014 | Status: Current
Situational crisis
Q:
How do you code ‘situational crisis’ as this term is not currently indexed in ICD-10-AM?
A:
Situational crisis is a culturally acceptable, normal reaction to a stressful life event, such as the death of a family
member or threatened job loss.
If, however, the symptoms are ongoing, beyond normal, acute stress or are more intense, it becomes a problem of
adjustment and the ongoing symptoms are now considered to have developed into a disorder. This may be described
as a situational crisis, but the main problem is one of adjustment.
Where 'situational crisis' is documented, coders should look for documentation within the clinical record or seek
clarification from the treating clinician to determine if the patient has a condition classifiable to Chapter 5 Mental and
behavioural disorders (F00-F99) for example, an acute stress reaction or an adjustment disorder. If documentation or
clinical advice clarifies that the patient has a mental or behavioural disorder, assign an appropriate code from F00-F99.
When clinical advice is unavailable, assign R45.89 Other symptoms and signs involving emotional state.
Improvements to the Alphabetic Index will be considered for a future edition of ICD-10-AM.
(Coding Rules, March 2014)
Ref No: Q2711 | Published On: 15-Mar-2014 | Status: Current
Stapled Transanal Rectal Resection (STARR)
Q:
What code should be assigned for stapled transanal rectal resection (STARR)?
A:
STARR (stapled transanal rectal resection) is performed for the treatment of rectal prolapse and/or rectocele in patients
with obstructive defaecation syndrome.
The procedure involves anterior and posterior full-thickness resection of the rectal wall resulting in a circumferential
transanal resection of the rectum.
Clinical advice supports the assignment of 32111-00 [933] Excision of rectal mucosa for rectal prolapse. Indexing
improvements will be considered for this procedure in a future edition of ACHI.
(Coding Rules, March 2014)
Current as at 24-Mar-2014 05:14
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2649 | Published On: 15-Mar-2014 | Status: Current
Confusion or delirium with dementia
Q:
How do you code confusion, acute confusion, confusional state and acute confusional state?
A:
Confusion NOS and delirium NOS are classified separately in ICD-10-AM.
Confusion NOS is a symptom of dementia and therefore where both of these conditions are documented,
only a code for the dementia should be assigned.
A code for delirium should only be assigned when this condition is documented OR when acute confusional state
is specifically documented, as per the index pathway:
State (of)
…
- confusional (psychogenic) F44.88
- - acute or subacute (see also Delirium) F05.9
A code for confusion, acute confusion, confusional state and acute confusional state should
only be assigned when the condition meets the criteria in ACS 0001 Principal diagnosis or
ACS 0002 Additional diagnoses.
Where:
CONFUSION NOS or ACUTE CONFUSION are documented - > assign R41.0 Disorientation, unspecified
ACUTE CONFUSIONAL STATE is documented -> assign F05.9 Delirium, unspecified (as a default – see also Delirium)
CONFUSIONAL STATE is documented, care should be taken before assigning F44.88 Other specified dissociative
[conversion] disorders.
This code should not be assigned unless documentation within the clinical record indicates that the patient has a
dissociative [conversion] disorder. Where documentation is inadequate, advice should be sought from the treating
clinician to determine if the patient has confusion, acute confusional state (ie delirium) or a true dissociative
[conversion] disorder.
Where ACUTE CONFUSIONAL STATE/DELIRIUM is specifically documented:
• due to another medical condition, assign F05.0 Delirium not superimposed on dementia, so described
• in a patient who also has dementia, assign F05.1 Delirium superimposed on dementia
• in a patient who also has dementia AND documentation states that the acute confusional state/delirium is due to a
general medical condition, assign F05.8 Other delirium
by following the index pathways:
State (of)
… - confusional (psychogenic) F44.88
- - acute or subacute (see also Delirium) F05.9
- - - with senility or dementia F05.1
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Coding Rules
ACCD Classification Information Portal
Delirium, delirious (acute or subacute) (not alcohol- or drug-induced) F05.9
…
- due to (secondary to)
…
- - general medical condition F05.0
…
- mixed origin (dementia and other) F05.8
…
- superimposed on dementia F05.1
Note: the documentation does not have to specify superimposed on dementia. The term superimposed implies
delirium with dementia.
If the documentation in the clinical record is unclear as to whether the patient has confusion or delirium, verification
should be sought from the treating clinician.
Amendments to the Alphabetic Index will be considered for a future edition.
(Coding Rules, March 2014)
Ref No: Q2734 | Published On: 15-Mar-2014 | Status: Current
Delirium with dementia
Q:
How do you classify delirium in a patient with dementia?
A:
Where delirium is specifically documented in a patient who also has dementia, assign F05.1 Delirium superimposed on
dementia by following the index pathways:
Delirium, delirious (acute or subacute) (not alcohol- or drug-induced) F05.9
…
- superimposed on dementia F05.1
Note: the documentation does not have to specify superimposed on dementia. The term superimposed implies delirium
with dementia.
(see also Coding Rules: Confusion or delirium with dementia)
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2672 | Published On: 15-Mar-2014 | Status: Current
Inappropriate behaviour due to acquired brain
injury.
Q:
How do you code the following scenario: patient presents with impulsive, disinhibited and inappropriate
behaviour due to a history of acquired brain injury as a result of a motor vehicle accident 10 years ago?
A:
For the scenario cited, refer to the guidelines in ACS 1912 Sequelae of injuries, poisoning, toxic effects and
other external causes:
The coding of sequelae of injury, poisoning, toxic effects or other external causes requires three codes:
• the residual condition or nature of the sequela (current condition)
• the cause of the sequela (the previous condition)
• the external cause of the injury, poisoning, toxic effect, etc.
The residual condition or nature of the sequela is sequenced first, followed by the cause of the late effect.
The following codes should be assigned for inappropriate behaviour due to an acquired brain injury as
the result of a past motor vehicle accident:
F07.8 Other organic personality and behavioural disorder due to brain disease, damage and dysfunction
T90.5 Sequelae of intracranial injury
Y85.0 Sequelae of motor-vehicle accident
with appropriate place of occurrence (Y92.-) code
By following the index pathways:
Disorder
- mental (nonpsychotic) (or behavioural)
- - following organic brain damage
- - - specified NEC F07.8
Sequelae
- injury NEC
- - - brain T90.5
(External cause of injury)
Sequelae
- motor vehicle accident Y85.0
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2683 | Published On: 15-Mar-2014 | Status: Current
Incisional inguinal hernia
Q:
How do you code an incisional inguinal hernia?
A:
Clinical advice indicates that incisional inguinal hernia is not a clinical concept. If this terminology is documented in the
clinical record, clarification should be sought from the treating clinician.
If clinical clarification cannot be obtained, the following advice should be followed:
• Where incisional inguinal hernia is documented and there has been a previous inguinal hernia repair, it is a recurrent
inguinal hernia and should be coded to K40 Inguinal hernia with a fifth character of 1 recurrent.
• Incisional hernias occur secondary to previous surgery, but NOT secondary to previous hernia surgery. Where incisional
inguinal hernia is documented and there is no evidence in the clinical record that there was a previous inguinal hernia
repair, assign a code from the range K43.0-K43.2.
(See also Coding Rules: Incisional hernia and Eighth Edition Education Workshop FAQs – Part 1/Hernia)
(Coding Rules, March 2014)
Ref No: Q2769 | Published On: 15-Mar-2014 | Status: Current
Examination and observation following fall from
pedestrian conveyance
Q:
Fall from a pedestrian conveyance appears to satisfy the definition for a transport accident, so should Z04.1 Examination
and observation following transport accident be assigned for examination and observation following fall from a
pedestrian conveyance?
A:
Examination and observation following fall from a pedestrian conveyance is classified to Z04.3 Examination and
observation following other accident, as fall from pedestrian conveyance (not in collision with pedestrian) is classified to
W02 Fall involving ice-skates, skis, roller-skates, skateboards, scooters and other pedestrian conveyances – which does
not fall within the range for a transport accident (V00-V99).
Amendments will be considered for a future edition of ICD-10-AM to clarify code selection.
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2725 | Published On: 15-Mar-2014 | Status: Current
Failure to progress in first or second stage of labour
Q:
There has been confusion regarding the clinical meaning of "failure to progress in 1st stage" or "failure to progress in
2nd stage" of labour. How do you code these conditions?
A:
Failure to progress (FTP) is a general term that may indicate protracted/prolonged cervical dilation or fetal descent or
complete arrest/cessation of cervical dilation or fetal descent.
FTP in labour may be caused by:
• fetal size/malpresentation
• pelvic size/shape/inadequacy
• abnormal uterine contractility
Failure/to/ progress (in labour) NEC is classified to O62.9 Abnormality of forces of labour, unspecified as per the index
pathway below:
Failure, failed
- to
- - progress (in labour) NEC O62.9
Note that O62.9 is a ‘not elsewhere classified’ code, so where documentation specifies the cause of the FTP, code the
cause instead of O62.9.
The clinical scenarios cited (FTP 1st stage and FTP 2nd stage) do not specify any cause for
the FTP. Therefore O62.9 Abnormality of forces of labour, unspecified should be assigned in both of these incidences.
Where prolonged labour (stage one or stage two) is documented with failure to progress, also assign an appropriate
code from O63 Long labour.
(See also Coding Rules: Failed trial of labour and failure to progress)
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2762 | Published On: 15-Mar-2014 | Status: Current
Endovenous thermal ablation of varicose veins
Q:
What is the correct procedure code to assign for endovenous radiofrequency ablation (RFA) or endovenous laser therapy
(EVLT) for the treatment of varicose veins?
A:
Endovenous thermal ablation is a new, minimally invasive endovenous technique for the treatment of varicose veins.
There are two types of endovenous thermal ablation that are in use: Endovenous radiofrequency ablation (RFA) and
endovenous laser therapy (EVLT). In contrast to the traditional ligation or stripping, RFA is designed to ablate the
incompetent veins through a percutaneously inserted catheter using imaging guidance. Through the catheter tip,
radiofrequency energy or laser energy is delivered to the wall of an incompetent vein, resulting in irreversible occlusion
of the vein.
Currently ACHI does not provide a specific code for EVLT or RFA for the treatment of varicose veins. Therefore assign
an appropriate site code from block [727] Interruption of sapheno-femoral or sapheno-popliteal junction varicose veins
to classify endovenous thermal ablation of varicose veins. An additional code will be created for this procedure for
Ninth Edition.
Bibliographies:
Medical Services Advisory Committee (MSAC) public summary document (2012): Application
No. 1166 - Radiofrequency ablation for the treatment of varicose veins due to chronic venous insufficiency.
Retrieved from: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/app1166-1
Weiss, M., Weiss, R., Feied, CF., Elston, DM., Crawford, GH., Albertini, JG., Butler,DF., Ratner, D.(2012).
Radiofrequency Ablation Therapy for Varicose Veins. Retrieved from: http://emedicine.medscape.com/article/1085800-overview#a15
(Coding Rules, March 2014)
Ref No: Q2774 | Published On: 15-Mar-2014 | Status: Current
Raynaud’s gangrene
Q:
How do you code Raynaud’s syndrome with gangrene?
A:
There is currently an inconsistency with the indexing of I73.0 Raynaud’s syndrome and the guidelines in the Conventions
used in the Tabular List of Diseases example 15 regarding gangrene in Raynaud’s syndrome. The guidelines in the
Conventions should be followed and two codes assigned for this condition.
That is, where Raynaud’s syndrome with gangrene/Raynaud’s gangrene is documented assign:
I73.0 Raynaud’s Syndrome
R02 Gangrene, not elsewhere classified
Amendments will be considered for a future edition to clarify the classification of Raynaud’s syndrome with and without
gangrene.
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2773 | Published On: 15-Mar-2014 | Status: Current
Hypertension due to acute kidney failure
Q:
Coding Q&A December 2011 Hypertension due to acute kidney disease advised that:
“Hypertension can arise due to acute kidney disease, therefore I15.0 Renovascular hypertension and I15.1 Hypertension
secondary to other kidney disorders can be assigned as per the guidelines in ACS 0925 Hypertension and related
conditions”
Could you clarify whether the reference to ‘acute kidney disease’ in the Q&A above also includes acute kidney failure?
A:
Unlike chronic kidney disease (CKD) which has a well-established definition, acute kidney disease is a general term with
no exact definition being described in the literature, although it has occasionally been used in reference to acute kidney
failure, the term which is now widely called acute kidney injury.
The term acute kidney disease in the Q&A cited is used broadly to mean all acute kidney diseases and disorders which
have been specified as the cause of hypertension including acute kidney failure and other acute kidney diseases such as
acute glomerulonephritis and acute interstitial nephritis.
Assign codes from category N17 Acute kidney failure and I15 Secondary hypertension when hypertension is documented
as being ‘due to’ or ‘secondary to’ acute kidney failure’ following the guidelines in ACS 0925 Hypertension and related
conditions/Secondary hypertension.
(Coding Rules, March 2014)
Ref No: Q2798 | Published On: 15-Mar-2014 | Status: Current
Threadlift procedure
Q:
How do you code threadlift procedure?
A:
Threadlift procedure (suture lift, stitch lift) is a minimally invasive, nonsurgical cosmetic procedure performed for facial
rejuvenation. Threadlift procedure is performed alone or in combination with fat/filler injection. The procedure is
performed under local anaesthesia, with or without intravenous sedation. Specialised suture material is inserted
subcutaneously through the hairline or behind the ear using a long needle, towards the area being lifted. The
threads/sutures are then used to pull the skin backwards towards the hairline to produce lift.
As there is no specific ACHI code for threadlift procedure, assign:
90676-00 [1660] Other procedures of skin and subcutaneous tissue following the index pathway:
Procedure
- skin (subcutaneous tissue) NEC 90676-00 [1660]
When fat/filler injection is also performed, assign 90660-00 [1602] Administration of agent into skin and subcutaneous
tissue.
(Coding Rules, March 2014)
Current as at 24-Mar-2014 05:14
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2786 | Published On: 15-Mar-2014 | Status: Current
Intraoperative floppy iris syndrome (IFIS)
Q:
What is the correct code to assign for intraoperative floppy iris syndrome?
A:
Intraoperative floppy iris syndrome (IFIS) is mainly encountered during cataract surgery and is characterised by a flaccid
iris, the tendency for the iris to prolapse
out of the incision and progressive intraoperative pupillary constriction. This triad of conditions although found during
surgery is commonly related to alpha1 adrenergic antagonist prescribed for relief of lower urinary tract symptoms of
benign prostatic hypertrophy (Friedman, 2009). Other drugs associated with IFIS include saw palmetto, finasteride,
antipsychotic drugs, angiotensin antagonists, and some beta-blockers with particular alpha-blocking properties.
Therefore, IFIS should be classified as an adverse effect of drug therapy and the following codes assigned:
H21.8 Other specified disorders of iris and ciliary body
H57.0 Anomalies of pupillary function
following the index pathways:
Prolapse, prolapsed
- iris (traumatic)
- - nontraumatic H21.8
Anomaly, anomalous (congenital) (unspecified type)
- pupil
- - function H57.0
and if a causal link is documented:
Y40–Y59 Drugs, medicaments and biological substances causing adverse effects in therapeutic use
Y92.22 Health service area
Indexing improvements will be considered for a future edition of ICD-10-AM.
Bibliography:
Friedman, AH. (2009). Tamsulosin and the Intraoperative Floppy Iris Syndrome. Journal of American Medical
Association: 301(19):2044-2045. doi:10.1001/jama.2009.704.
Liaboe, L., Baker, M. & Oetting, T. (2013). Floppy Iris Syndrome. EyeRounds.org.
Retrieved from: http://webeye.ophth.uiowa.edu/eyeforum/cases/169-IFIS.htm
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2796 | Published On: 15-Mar-2014 | Status: Current
Endobronchial valve
Q:
What is the correct code to assign for insertion or removal of endobronchial valve(s)?
A:
Endobronchial valve placement is a new, minimally invasive technique that is currently being investigated as a treatment
option for a number of lung conditions. One of the most common uses is to treat emphysema where the alveoli (air sacs)
in the lungs lose their elasticity leading to hyperextension of the lung.
The procedure involves placing an endobronchial valve(s) to the target location of the bronchial tree
through either a fibreoptic or rigid bronchoscope. Single or multiple valves may be inserted during the procedure. The
valve inserted is a one way valve which prevents air from flowing into the over-inflated region of the lung during
inspiration but allows air and secretions to exit during expiration. Over time, the reduction in airflow to the diseased
portions of the lung may improve the elastic recoil which in turn improves lung function.
Currently ACHI does not provide a specific code for insertion or removal of endobronchial valve(s). Classification of
bronchoscopic interventions are currently under review.
For insertion of endobronchial valve(s), assign:
90165-00 [547] Other procedure on bronchus.
An additional code for bronchoscopy should also be assigned as per ACS 0023 Laparoscopic/arthroscopic/endoscopic
surgery.
For removal of endobronchial valve(s), assign:
41898-03 [544] Fibreoptic bronchoscopy with removal of foreign body
OR
41895-00 [544] Rigid bronchoscopy with removal of foreign body
References:
NICE (National Institute for Health and Clinical Excellence) Interventional Procedure overview (2009). Bronchoscopic lung volume reduction with airway
valves for advanced emphysema. Retrieved from http://www.nice.org.uk/nicemedia/pdf/IP%20770%20Bronchoscopic%20lung%20volume%20reduction%
20for%20advanced%20emphysema%20post%20IPAC%20141209%20for%20web.pdf Q2796_Final_Endobronchial valve.doc Page 5 13/03/2014
Olympic Respiratory Amercia (2012). Wish there was something different you could do to control postoperative air leaks? Retrieved from:
http://www.spiration.com/downloads/Airleaks/US/Approved%20Site%20Flyer.pdf
Shah, P.L. & Herth F.J. (2013). Current status of bronchoscopic lung volume reduction with endobronchial valves. Thorax. doi:10.1136/thoraxjnl-2013-203743
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2797 | Published On: 15-Mar-2014 | Status: Current
Purple Toe Syndrome
Q:
How do you code purple toe syndrome?
A:
Purple toe syndrome occurs rarely as an adverse effect of warfarin. The patient develops bilateral purple discolouration
of the feet usually within a short time of commencing warfarin therapy due to the release of atheromatous plaque
emboli and cholesterol microemboli that have lodged in the vessels of the peripheries. Purple toe syndrome is
synonymous with blue toe syndrome and cholesterol embolism syndrome.
Where purple toe syndrome is documented as an adverse effect of warfarin, assign a code from I70.2 Atherosclerosis of
arteries of extremities, by following the index pathways:
Atheroembolis – see Arteriosclerosis
OR
Blue
- toe syndrome – see Arteriosclerosis
Arteriosclerosis
- extremities I70.20
- - with
- - - gangrene I70.24
- - - intermittent claudication I70.21
- - - rest pain I70.22
- - - ulceration I70.23
Assign additional codes:
Y44.2 Anticoagulants causing adverse effects in therapeutic use
Y92.22 Health service area
Amendments to ICD-10-AM Alphabetic Index will be considered for a future edition.
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2799 | Published On: 15-Mar-2014 | Status: Current
CADASIL
Q:
What is the correct code to assign for cerebral autosomal dominant arteriopathy with subcortical infarcts and
leukoencephalopathy (CADASIL)?
A:
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary
condition caused by a mutation in the NOTCH3 gene on chromosome 19q12. Accumulation of the pathologic NOTCH3
receptor protein in small and medium-sized cerebral arteries is responsible for thickening and fibrosis of the walls of
these arteries resulting in cerebral infarctions. CADASIL is characterized by the clinical tetrad of dementia, psychiatric
disturbances, migraine, and recurrent strokes. All components may not be present and the severity of associated
symptoms and mode of presentation are highly variable. The most frequent presentation is recurrent ischaemic
cerebrovascular episodes (transient ischemic attacks or cerebral infarctions) (Behrouz R, 2013).
There is no specific code for CADASIL in ICD-10-AM Eighth Edition.
Clinical advice indicates that I67.3 Progressive vascular leukoencephalopathy is the most appropriate for CADASIL in
ICD-10-AM.
Assign I67.3 Progressive vascular leukoencephalopathy following the index pathway:
Leukoencephalopathy (see also Encephalopathy)
- vascular, progressive I67.3
The manifestations of CADASIL, for example stroke or dementia, should be coded if they meet the criteria in ACS 0001
Principal diagnosis and ACS 0002 Additional diagnoses.
Please note “Assignment of Chapter 17 Congenital malformations,deformations and chromosomal abnormalities
codes (Q00-Q99) as additional diagnoses” advice published 15 September 2006 (Coding Matters, Volume 13, Number
2) has been updated to remove the references to CADASIL.
References:
Behrouz, R. (2013). CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) clinical presentation. Retrieved from:
http://emedicine.medscape.com/article/1423170-clinical
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2803 | Published On: 15-Mar-2014 | Status: Current
Focal segmental glomerulosclerosis (FSGS)
Q:
What is the correct code to assign focal segmental glomerulosclerosis (FSGS)?
A:
Focal segmental glomerulosclerosis (FSGS) is a type of kidney disease that scars parts of the glomeruli, the filtering units
of the kidney. The scarring occurs only in some of the glomeruli and only part of the individual glomerulus is damaged.
FSGS causes asymptomatic proteinuria or nephrotic syndrome with or without renal insufficiency. The natural history of
FSGS is variable and can range from oedema that is difficult to manage, to proteinuria that is refractory to
corticosteroids and other immunosuppressive agents, to worsening hypertension and a progressive loss of renal
function (Rao, S.T.K. 2013).
For documentation of FSGS assign an appropriate code from N00-N07, with a fourth character of .1 following the index
pathway:
Sclerosis, sclerotic
- focal and segmental (glomerular) — code to N00–N07 with fourth character .1.
The appropriate codes are:
N00.1 Acute nephritic syndrome, focal and segmental glomerular lesions
N01.1 Rapidly progressive nephritic syndrome, focal and segmental glomerular lesions
N02.1 Recurrent and persistent haematuria, focal and segmental glomerular lesions
N03.1 Chronic nephritic syndrome, focal and segmental glomerular lesions
N04.1 Nephrotic syndrome, focal and segmental glomerular lesions
N05.1 Unspecified nephritic syndrome, focal and segmental glomerular lesions
N06.1 Isolated proteinuria with focal and segmental glomerular lesions
N07.1 Hereditary nephropathy, not elsewhere classified, focal and segmental glomerular lesions
Clarification should be sought from the clinician if the documentation in the clinical record does not support assignment
of an appropriate code as per the list above.
When clarification from the clinician is not possible, clinical advice indicates that N03.1 Chronic nephritic syndrome, focal
and segmental glomerular lesions is the most appropriate code.
Indexing improvements will be considered for this condition for a future edition of ICD-10-AM.
References:
Rao, S.T.K. (2013). Focal Segmental Glomerulosclerosis. Emedicine.medscape.com.
Retrieved from: http://emedicine.medscape.com/article/245915-overview
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2805 | Published On: 15-Mar-2014 | Status: Current
Primary osteoarthritis
Q:
How do you classify osteoarthritis NOS?
A:
To classify osteoarthritis NOS clinical coders should be guided by the instructional note in ICD-10-AM Tabular List at M15M19:
ARTHROSIS
(M15–M19)
Note: In this block the term osteoarthritis is used as a synonym for arthrosis or osteoarthrosis.
The term primary has been used with its customary clinical meaning of no underlying or determining
condition identified.
Excludes: osteoarthritis of spine (M47.-)
The note is consistent with the guidelines in ACS1343 Erosion of knee.
Therefore, Osteoarthritis/arthrosis/osteoarthrosis NOS is classified as primary osteoarthritis, meaning that no
underlying condition has been identified.
Where osteoarthritis of the knee is documented without further specification, follow the index pathway for
Osteoarthritis/knee/primary:
Osteoarthritis
- knee
- - primary (unilateral) M17.1 Other primary gonarthrosis
- - - bilateral M17.0 Primary gonarthrosis, bilateral
Consideration to amending the ICD-10-AM Alphabetic Index to clarify the classification of osteoarthritis will be made for
a future edition.
(Coding Rules, March 2014)
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2816 | Published On: 15-Mar-2014 | Status: Current
Faecal microbiota transplantation (FMT)
Q:
What is the correct procedure code to assign for faecal microbiota transplantation?
A:
Faecal microbiota transplantation (FMT), also known as faecal bacteriotherapy, faecal transplant, intestinal microbiota
transplantation (IMT) or human probiotic infusion, is an alternative treatment for patients who have failed standard
treatment for Clostridium difficile infections (CDI). The procedure involves collecting a stool sample from a healthy donor,
processing it into a liquid suspension and instilling it into the gastrointestinal tract via various routes including nasogastric
or nasoenteric tube, gastroduodenoscopy, flexible sigmoidoscopy, colonoscopy or enema. Instillation by colonoscopy to
caecum is the preferred method for the vast majority of FMTs based on the results of published studies.
The correct code to assign for FMT is:
92075-00 [1895] Gastrointestinal tract instillation, except gastric gavage
An additional code should also be assigned where the microbiota installation is delivered via an endoscope as per
ACS 0023 Laparoscopic/arthroscopic/endoscopic surgery. For example:
32090-00 [905] Fibreoptic colonoscopy to caecum
The classification of FMT will be reviewed for a future edition of ACHI.
Bibliography:
Brandt, L.J. & Aroniadis, O.C. (2013). An overview of fecal microbiota transplantation: techniques, indications, and outcomes.
Gastrointestinal Endoscopy, 78 (2), pages 240-249. Doi:10.1016/j.gie.2013.03.1329
Gough, E., Shaikh, H. and Manges, A.R. (2001). Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy)
for Recurrent Clostridium difficile Infection. Clinic Infection Diseases, 53 (10), pages 994-1002. Doi:10.1093/cid/cir632
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2819 | Published On: 15-Mar-2014 | Status: Current
Thrombin injection into false aneurysm
Q:
What is the correct code for percutaneous thrombin injection into false aneurysm?
A:
A false aneurysm (also known as a pseudoaneurysm), is leakage of arterial blood when there is a breach in the vessel wall
but is contained by the adventitia or surrounding perivascular soft tissue. False aneurysms may occur after arterial
puncture for a diagnostic cardiac catheterisation, an arteriogram or after an arterial intervention.
One treatment option for false aneurysms is a minimally-invasive procedure performed under local anaesthesia whereby
a needle is placed percutaneously into the false aneurysm under ultrasound guidance with injection of thrombin, an
enzyme that promotes rapid clot formation and thus obliterating the false aneurysm cavity when injected.
The most appropriate code for thrombin injection into false aneurysm is 45027-01 [742] Administration of agent into
vascular anomaly following the index pathway:
Injection
- vascular
- - anomaly 45027-01 [742]
- - malformation 45027-01 [742]
Improvements will be considered for this procedure for a future edition of ACHI.
References:
Weerakkody Y, D’Souza D, et al (no date). False aneurysm. Retrieved from: http://radiopaedia.org/articles/false_aneurysm
Webber G, Jang J, Gustavson S and Olin J (2007). Contemporary Management of Postcatheterization Pseudoaneurysms. Retrieved from:
http://circ.ahajournals.org/content/115/20/2666.full
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Ref No: Q2834 | Published On: 15-Mar-2014 | Status: Current
Occlusion of coronary artery bypass grafts
Q:
A patient with a history of coronary artery bypass grafts (CABGs) is electively admitted for a coronary angiogram to
investigate the cause of their chest pain. The coronary angiogram report reveals occlusion of the existing bypass grafts
and there is no plan for reoperation.
What is the correct code to assign for occlusion of coronary bypass grafts?
A:
Occlusion of coronary bypass grafts may occur as a result of natural disease progression leading to atheroma formation
in the implanted arteries or veins. It may also be caused by acute graft failure mainly attributable to acute graft
thrombosis, graft kinking/overstretching, postoperative graft spasm or anastomotic stenosis. Therefore, code
assignment should be guided by the documentation in the clinical record.
If it is clear from the documentation that occlusion of a coronary bypass graft is due to atherosclerosis, assign:
I25.12 Atherosclerotic heart disease of autologous bypass graft
or
I25.13 Atherosclerotic heart disease of nonautologous bypass graft.
If the documentation specifies that the occluded coronary bypass graft is caused by a complication of the graft assign:
T82.8 Other specified complications of cardiac and vascular prosthetic devices, implants and grafts. Additional codes
such as I24.0 Coronary thrombosis not resulting in myocardial infarction should also be assigned to provide further
specification of the condition, as per ACS 1904 Procedural complications.
T82.8 should only be assigned when there is a documented link between an occluded graft and the initial surgery, as per
ACS 1904 Procedural complications/readmission for treatment of procedural/postprocedural complications:
• If documentation does not state that the condition arose as a complication of the initial surgery, only the condition is
coded
• Where documentation clearly states that the condition arose as a complication of the initial surgery the condition
should be coded as a procedural/post procedural complication
If occlusion of a coronary bypass graft is documented without further specification, clarification should be sought from
the clinician. Where this is not possible, assign:
I25.12 Atherosclerotic heart disease of autologous bypass graft
or
I25.13 Atherosclerotic heart disease of nonautologous bypass graft.
This is consistent with the advice in ACS 0941 Arterial disease that occlusion is usually due to atherosclerosis.
Likewise embolism of CABG from the rupture of intimal plaque may occur spontaneously in acute coronary syndrome
or iatrogenically during percutaneous coronary interventions.
Therefore, code assignment for embolism of CABG should be guided by the following from ACS 0940 Ischaemic heart
disease:
“Embolism or occlusion of a bypass graft is classified to T82.8 Other specified complications of cardiac and vascular
prosthetic devices, implants and grafts.”
AND ACS 0941 Arterial disease/Embolism:
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“If embolism of a coronary artery is documented (and the patient has not progressed to myocardial infarction), assign
I24.0 Coronary thrombosis not resulting in myocardial infarction.
In the latter case where the patient progresses to myocardial infarction, assign an appropriate code from category I21
Acute myocardial infarction.
The presence of atherosclerosis (for example in atheroembolism) where documented should also be indicated by an
additional diagnosis code from category I25.1- Atherosclerotic heart disease.”
Q:
Would the code assignment differ if reoperation was planned for the occluded CABGs?
A:
Occlusion of CABGs can be treated medically or surgically depending on clinical and angiographic characteristics. Code
selection for this condition is not altered by the choice or priority of treatment option.
Q:
According to ACS 0909 Coronary artery bypass graft and ACS 0940 Ischaemic heart disease, a diseased graft is classified to
I25.12 Atherosclerotic heart disease of autologous bypass graft
Or
I25.13 Atherosclerotic heart disease of nonautologous bypass graft and an occluded graft is classified to
T82.8 Other specified complications of cardiac and vascular prosthetic devices, implants and grafts.
Is there difference between a diseased graft and an occluded graft?
A:
The terms diseased graft and occluded graft are interchangeable. As stated above, code assignment for each case is
based on the clinical documentation. If the cause of bypass graft occlusion cannot be established based on the available
documentation, clarification should be sought from the clinician. Where this is not possible, assign:
I25.12 Atherosclerotic heart disease of autologous bypass graft
or
I25.13 Atherosclerotic heart disease of nonautologous bypass graft.
Consideration will be given to reviewing the ACS with respect to coronary bypass graft occlusion
in a future edition.
References:
Baim, D.S., Wahr, D., George B, Leon, M.B., Greenberg, J., Cutlip, D.E., Kaya, U., Popma, J.J., Ho, K., Kuntz, R.E. (2002). Randomized trial of a distal embolic protection device
during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation, 105:1285–1290. Available: http://www.invasivecardiology.com/article/2512
Beijk, M.A. and Harskamp, R.E. (2013). Treatment of Coronary Artery Bypass Graft Failure, Artery Bypass, Dr Wilbert S. Aronow (Ed.). DOI: 10.5772/54928.
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Ref No: Q2843 | Published On: 15-Mar-2014 | Status: Current
ACS 1615 Specific interventions for the sick neonate –
Catheterisation and infusions
Q:
Should 13300-00 [738] Catheterisation/cannulation of other vein in neonate be allocated three times because three
different sites were used for cannulation?
A:
The procedure code 13300-00 [738] Catheterisation/cannulation of other vein in neonate has been removed from ACS
1615 (see below) as per errata 2, December 2013, and as such should not be coded.
Catheterisation in a neonate
13300-01 [738] Scalp vein catheterisation/cannulation in neonate
13300-02 [738] Umbilical vein catheterisation/cannulation in neonate
13319-00 [738] Central vein catheterisation in neonate
13303-00 [694] Umbilical artery catheterisation/cannulation in neonate
Note: When multiple catheterisations are performed during an episode of care and the same procedure code
applies, assign the procedure code once only
Q:
As ACS 1615 Specific interventions for the sick neonate now requires both the catheterisation/cannulation and the
infusion to be coded in neonates, why do the words “Includes: infusion” appear at these codes within blocks 738 and
694 to indicate that the infusion of the substance is not required?
A:
Infusion should be coded (when the criteria are met) in addition to catheterisation in a neonate only for the specific
infusions listed in ACS 1615 and ACS 0302 Blood transfusions. That is:
• Parenteral fluid therapy
• Parenteral antibiotics/anti-infectives
• Blood products.
Consideration will be given to removing the includes note in a future edition.
Q:
If catheterisation/cannulation codes are now required for neonates why is there not a “Code also when performed”
note in block 1920 to alert coders to also code the catheterisation/cannulation for neonates?
A:
Block [1920] Administration of pharmacotherapy has a reference to ACS 1615 Specific interventions for the sick
neonate, indicating the guidelines in this standard should be followed to clarify which catheterisation/cannulation
should be coded for neonates. There is no need to add a note to the Tabular List.
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Q:
Aren’t catheters the “route” of administration for infusions and therefore not to be coded?
A:
Catheterisations are the route of administration for infusions and would not normally be coded, however,
catheterisations in a neonate must be coded as per the criteria in ACS 1615. This is a specialty standard and the
guidelines regarding the assignment of codes for catheterisations are included in this standard as they are clinically
significant procedures when performed on neonates. This advice is reinforced in ACS 0042 Procedures normally not
coded, point 5 which exempts catheterisation in neonates.
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