Coding Rules
ACCD Classification Information Portal
Ref No: Q2720 | Published On: 15-Jun-2014 | Status: Current
Excision of neuroblastoma
Q:
Should the specific ACHI codes for neuroblastomas always be used when a neuroblastoma is removed, or can other
more anatomically correct codes be used such as 40309-00 [53] Removal of spinal extradural lesion?
A:
The following site specific codes are available in ACHI for removal of neuroblastomas:


43987-01 [989] Excision of intra-abdominal neuroblastoma
43987-00 [563] Excision of intrathoracic neuroblastoma
For excision of neuroblastomas of other sites, assign 43987-02 [80] Excision of neuroblastoma, not elsewhere classified,
following the index pathway:
Excision
- neuroblastoma NEC 43987-02 [80]
As per the definition in the Conventions used in the tabular list of interventions, the NEC indicates that this is the
default option if the site of the neuroblastoma is not intra-abdominal or intrathoracic. It does not indicate that another
index pathway can be selected to achieve a more site specific code.
(Coding Rules, June 2014)
Ref No: Q2764 | Published On: 15-Jun-2014 | Status: Current
Sepsis with organ failure
Q:
If sepsis is documented and the patient is in acute organ failure, can we assume severe sepsis and assign R65.1
Systemic inflammatory response syndrome [SIRS] of infectious origin with acute organ failure?
A:
ACS 0110 Sepsis, severe sepsis and septic shock contains definitional information relating to the concepts of systemic
inflammatory response syndrome (SIRS), infection, sepsis, severe sepsis and septic shock. These definitions are
provided for reference and guidance, but should not be used to determine code assignment. The Classification section
of ACS 0110 should be referenced for specific advice regarding the coding of these conditions.
A code from R65 Systemic inflammatory response syndrome (SIRS) should only be assigned:


where SIRS is documented
as an additional code where there is documentation of severe
sepsis.
Do not assume severe sepsis when there is documentation of sepsis with organ failure. Coders should check with the
treating clinician if unsure of whether to assign codes for sepsis or severe sepsis due to documentation issues.
A review of ACS 0110 will be considered for a future edition.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2755 | Published On: 15-Jun-2014 | Status: Current
Dissection of coronary artery during angioplasty
Q:
What is the correct code to assign for dissection of the coronary artery during angioplasty?
A:
Coronary artery dissection is a significant complication associated with coronary angioplasty interventions. It may occur
during interventional angioplasties such as directional coronary atherectomy or transluminal extraction coronary
atherectomy where a guide wire/catheter is wedged into the wall of a blood vessel, resulting in mechanical trauma to
the inner layer of the coronary artery; or during the conventional balloon angioplasty where the balloon is intended to
inflate and compress the plaque but the dilation force created by the balloon exceeds the elastic threshold of the blood
vessel, causing an internal split.
There are certain factors such as an underlying arteriopathy or operative technique that may increase the risk of
coronary artery dissection, however the occurrence of coronary artery dissection during angioplasties is directly or
indirectly related to use of cardiac and vascular devices (as described above). ACS 1904 Procedural complications
states:
͞Where the complication relates to a prosthetic device, implant or graft, such as a cardiac valve, look up the main term
Complication(s) and then by the device (if known and listed) or by the subterm of 'prosthetic device, implant or graft͟
Therefore, the correct code to assign for coronary artery dissection during coronary angioplasty interventions is T82.8
Other specified complications of cardiac and vascular prosthetic devices, implants and grafts by following the index
entry:
Complications (from) (of)
- balloon implant or device
- -vascular (counterpulsation)
- - - specified NEC T82.8
OR
Complications (from) (of)
- cardiac (see also Disease/heart)
- - device, implant or graft
- - - specified NEC T82.8
Also assign an additional code to further specify the condition as per the guidelines in ACS 1904 Procedural
complications/ Classification of Procedural Complications:
͞An additional code from Chapters 1 to 19 should be assigned where it provides further specificity.͟
For documentation of coronary artery dissection, assign I25.4 Coronary artery aneurysm. This code is to be updated to
specify I25.4 Coronary artery aneurysm and dissection as part of the 2013 WHO URC updates to be incorporated in the
Ninth Edition of ICD-10-AM, and is therefore, the most appropriate code to assign.
As the dissection occurs intraoperatively, assign Y65.8 Other specified misadventures during surgical and medical care
and Y92.22 Health service area also as per the guidelines in ACS 1904 Procedural complications/ Classification of
external causes of procedural complications/ misadventure.
Additional index entries for coronary artery dissection will be created for a future edition.
References:
Kern, M.J. (2012). The Interventional Cardiac Catheterization Handbook (3rd ed). Expert Consult, Online. Elsevier Health Sciences, 116-118. Retrieved from:
http://elibrary.rajavithi.go.th/homelibrary/EBook_data/page52/The%20Interventional%20Cardiac%20Catheterization%20Handbook%20%203e.pdf
Rogers, J. H., & Lasala, J.M. (2004). Coronary artery dissection and perforation complicating percutaneous coronary intervention. The Journal of Invasive Cardiology; 16(9).
Retrieved from: http://www.invasivecardiology.com/article/3052 (Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2768 | Published On: 15-Jun-2014 | Status: Current
Contrast induced acute kidney failure (injury)
Q:
What is the correct code to assign for contrast induced Acute Kidney Failure (AKF) or contrast-induced Acute Kidney
Injury (AKI)?
A:
Contrast induced AKF (now commonly known as AKI) refers to an abrupt deterioration in kidney function which occurs
after exposure to contrast media. The codes below are commonly assigned for this condition by following the index
pathway Failure/kidney/acute and reinforced by Example 6 in ACS 0401 Diabetes mellitus and intermediate
hyperglycaemia:



N17.9 Acute kidney failure, unspecified
Y57.5 X-ray contrast medium causing adverse effects in therapeutic use
Y92.22 Place of occurrence, health service area
However, assignment of N17.9 is incorrect if the excludes note (which is consistent with ICD-10) at N17-N19 Kidney
failure is followed:
͞Excludes: drug- and heavy-metal-induced tubulo-interstitial and tubular conditions (N14.-)͟
Analysis of code assignment in the data suggests it would be a major change in coding practice to assign N14.1
Nephropathy induced by other drugs, medicaments and biological substances rather than N17.9 Acute kidney failure,
unspecified for contrast induced acute kidney failure (injury), therefore clinical coders should continue to assign N17.9
until further notice.
The classification for contrast induced AKI will be reviewed for a future edition of ICD-10-AM.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2811 | Published On: 15-Jun-2014 | Status: Current
Complication of a skin flap
Q:
What code is assigned for complication (eg necrosis) of skin flap?
A:
ICD-10-AM classifies procedural complications according to the type of procedure that was performed and this is
supported by the Alphabetic Index and the guidelines for classifying procedural complications in ACS 1904 Procedural
complications.
A rotation flap is a type of tissue transplant. Therefore, a complication of a skin flap that meets the criteria for coding
should be classified to:
T86.88 Failure and rejection of other transplanted organs and tissues by following the index pathway:
Complications (from) (of)
͙- organ or tissue transplant, failure or rejection (immune or nonimmune cause) (partial) (total) T86.9
͙- - skin (allograft) (autograft) T86.88
- - specified NEC T86.88
Assign an additional code where it provides further specificity (as per ACS 1904 Procedural complications), for example
R02 Gangrene for necrosis.
Assign Y83.4 Other reconstructive surgery by following the External Causes of Injury index pathway:
Complication
͙- transplant, transplantation (heart) (kidney) (liver) (whole organ, any) Y83.0
- - partial organ Y83.4
and Y92.22 Health service area
The ACCD will consider amendments to ICD-10-AM Alphabetic Index for a future edition.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2821 | Published On: 15-Jun-2014 | Status: Current
Total hip replacement revision wound infection
Q:
What is the correct code to assign for wound infection following a revision of a total hip replacement?
A:
The correct code to assign for superficial (skin and subcutaneous) and deep (soft tissue) surgical wound infections
following a revision total hip replacement is T81.41 Wound infection following a procedure, following the index
pathway:
Infection, infected (opportunistic)
- postprocedural wound T81.41
When there is a direct causal relationship between the joint prosthesis and postprocedural infection for example
postprocedural pyogenic arthritis of the hip due to the infected joint prosthesis, assign T84.5 Infection and
inflammatory reaction due to internal joint prosthesis, following the index pathway:
Infection, infected (opportunistic)
- due to or resulting from
- - device, implant or graft (see also Complications/by site and type)
- - - joint prosthesis T84.5
This advice is supported by guidelines in ACS 1904 Procedural complications, Hospital acquired wound infection.
(Coding Rules, June 2014)
Ref No: TN697 | Published On: 15-Jun-2014 | Status: Current
Sclerotherapy of lesion of large intestine
Q:
How do you code injection of sclerosing agent into lesion of large intestine?
A:
Sclerotherapy (injection of sclerosing agent) is a type of destruction procedure that involves injection of a chemical
irritant into a vein to produce hardening and destruction of the vein. The chemical irritates the lining of the vein,
causing it to swell and the blood to clot. Scar tissue is produced, the vein shrinks and blood flow deviates to other
healthy blood vessels.
When endoscopic sclerotherapy (injection of sclerosing agent) into lesion of large intestine is performed, assign 9030800 [908] Endoscopic destruction of lesion of large intestine by following the index pathway:
Destruction
͙- lesion (tumour)
͙- - intestine, large
- - - endoscopic (closed) 90308-00 [908]
Amendments to ACHI Alphabetic Index will be considered for a future edition.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
Page 5 of 20
Coding Rules
ACCD Classification Information Portal
Ref No: Q2830 | Published On: 15-Jun-2014 | Status: Current
Necrotic leg ulcer with diabetes mellitus and
peripheral vascular disease (PVD)
Q:
What is the correct code assignment for a principal diagnosis of leg (not foot) ulcer with necrotic tissue, on a
background of type 2 diabetes with PVD; where the PVD meets the criteria for code assignment as per ACS 0002
Additional diagnoses, but there is no documentation of a clear relationship between the ulcer, gangrene and PVD.
Should L97 or I70.23 be assigned as the principal diagnosis?
A:
The Alphabetic Index provides a ͚with͛ association for peripheral vascular disease and ulceration of the extremities, so
there is no need to identify a relationship between the ulcer, gangrene and PVD. The appropriate codes to assign for a
leg ulcer with necrotic tissue, on a background of type 2 diabetes mellitus with peripheral vascular disease (PVD) are:
I70.23 Atherosclerosis of arteries of extremities with ulceration
E11.69 Type 2 diabetes mellitus with other specified complication
E11.52 Type 2 diabetes mellitus with peripheral angiopathy with gangrene
following the index pathways:
Arteriosclerosis, arteriosclerotic
͙- extremities
- - with
- - - ulceration I70.23
Diabetes, diabetic
- with
͙- - angiopathy, peripheral (without gangrene)
- - - with
- - - - gangrene E1-.52
͙- - peripheral vascular disease (PVD) Ͷsee Diabetes/with/angiopathy, peripheral
͙- - ulcer, skin
- - - lower extremity E1-.69




Diabetes with peripheral vascular disease with necrosis is classified to E11.52 Type 2 diabetes mellitus
with peripheral angiopathy, with gangrene.
Peripheral vascular disease with ulceration is classified to I70.23 Atherosclerosis of arteries of extremities
with ulceration.
E11.69 Type 2 diabetes mellitus with other specified complication is assigned following Rule 4a in ACS
0401 Diabetes mellitus and intermediate hyperglycaemia to classify diabetes with leg ulcer.
Neither I70.24 Atherosclerosis of arteries of extremities with gangrene or L97 Ulcer of lower limb, not
elsewhere classified are assigned as per Rule 6 of ACS 0401 Diabetes mellitus and intermediate
hyperglycaemia.
Also note, that I70.2- codes are not mutually exclusive, more than one can be assigned where multiple manifestations
of PVD are documented.
Indexing amendments will be considered for a future edition of ICD-10-AM to improve the index pathways, particularly
under the lead term Ulcer.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2831 | Published On: 15-Jun-2014 | Status: Current
Manual removal of placenta in a single vaginal
delivery
Q:
What is the correct delivery code to assign for a single vaginal delivery with manual removal of placenta (i.e. O80 Single
spontaneous delivery or O83 Other assisted single delivery)?
A:
For classification purposes the O80-O84 range of codes describe the delivery component of an obstetric episode of
care, including expulsion of the placenta. O80 Single spontaneous delivery is intended to describe those deliveries with
minimal or no assistance. O83 Other assisted single delivery describes those with more than minimal assistance,
including breech extraction, version with extraction etc.
Separation of the placenta is a normal part of the delivery process and common techniques to facilitate delivery of the
placenta include controlled cord traction (CCT) or fundal expression after spontaneous or oxytocin induced placental
separation. Manual removal of the placenta (MROP) is quite different, being performed for reasons such as:



Failure of delivery of the placenta more than one hour after delivery of the fetus
Excessive loss of blood before the placenta has been delivered and the placenta needs to be removed
manually to reduce the continuing blood loss
Retained placental tissue within the uterus soon after the expulsion of the placenta, which may be due to
partial or complete morbid adhesion (eg placenta accrete, or placenta percreta), requiring the patient to be
transferred from the delivery suite to operating room for MROP
In these situations the correct delivery code to assign is O83 Other assisted single delivery as there is more than
minimal assistance required.
However O83 Other assisted single delivery should not be assigned where portions of placenta remain in the uterus and
require evacuation of retained tissue at a later stage, as the initial delivery process required only minimal assistance.
This would be considered a later complication of incomplete removal of the placenta and O80 Single spontaneous
delivery should be assigned.
Improvements to ICD-10-AM will be considered for a future edition to reflect this advice.
References:
Tandberg A., Albrechtsen S. and Iversen O.E. (1999). Manual removal of the placenta, Incidence and clinical significance. Acta Obstetricia et Gynecologica Scandinavica, Vol
78, pages: ϯϯʹϯϲ͘
Foster J.C. (2007). Graduate nurse-midwife curriculum tutorial 2: birth of the placenta. College of nursing, University of Utah. Spencer S. Eccles Health Sciences Library.
Available:
http://library.med.utah.edu/nmw/mod2/Tutorial2/manual_removal.html
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2839 | Published On: 15-Jun-2014 | Status: Current
Aspiration pneumonia
Q:
Is it mandatory to assign an external cause code with J69.0 Pneumonitis due to food and vomit for documentation of
aspiration pneumonia?
A:
Codes U50-Y98 must be assigned (as additional codes) to identify the external cause of conditions classified in Chapter
19 Injury, poisoning and certain other consequences of external causes (S00-T98) and with codes Z04.1-Z04.5 (see ACS
2001 External cause code use and sequencing).
An external cause code may also be assigned for conditions outside of this range to specify the external cause of a
condition.
The instructional note at J69 Pneumonitis due to solids and liquids ʹ Use additional external cause code (Chapter 20) to
identify cause ʹ is consistent with that in ICD-10 (and its modifications) and applies to all of the codes in the category
and so should be assigned when its addition provides further specificity. For example when the external cause is
specified as:
Food ʹ also assign W79 Inhalation and ingestion of food causing obstruction of respiratory tract
or
Vomit ʹ also assign W78 Inhalation of gastric contents.
Where aspiration pneumonia is documented and there is no indication of what was aspirated, do not assign an external
cause code, as it will not provide any additional information.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2841 | Published On: 15-Jun-2014 | Status: Current
Microscopically controlled serial excision of skin
lesions
Q:
How many times should 31000-00 [1626] Microscopically controlled serial excision of lesion(s) of skin be assigned, if the
patient has multiple sections taken from one lesion?
A:
Microscopically controlled serial excision of a skin lesion (Mohs chemosurgery) involves sections of tissue being excised
around the target lesion and examined microscopically for evidence of neoplastic cells. The patient is held in recovery
after each section is excised and is taken back into the operating room for further tissue removal if the findings are
positive. This process may include a number of returns to the operating room (stages) and a number of sections being
removed for a single lesion, until all neoplastic cells are removed. Clinically, this procedure is identified as one
operative episode/visit to theatre. Therefore, the guidelines in ACS 0020 Bilateral/Multiple procedures/Multiple
procedures/Classification/(point)1 do not apply.
Regardless of the number of stages or sections removed for a single lesion, this procedure fulfils the criteria in ACS
0020 Bilateral/Multiple procedures/Classification/(point)5:
5. Skin or subcutaneous lesion removal, excision or biopsy
For multiple excisions or biopsies or removals performed on:
 separate skin lesions: assign relevant code(s) as many times as it is performed
 same lesion: assign relevant code once
Therefore, where this procedure is performed on a single lesion, assign 31000-00 [1626] Microscopically controlled
serial excision of lesion(s) of skin once only, as implied by the terms serial excision in the code title. This code would
only be assigned more than once if it was performed for multiple lesions during the same visit to theatre.
Amendments to ACHI and the ACS will be considered for a future edition.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2842 | Published On: 15-Jun-2014 | Status: Current
Transfusion Related Acute Lung Injury (TRALI)
Q:
What code do you assign for transfusion related acute lung injury (TRALI)?
A:
Transfusion related acute lung injury (TRALI) is an acute immunological transfusion reaction that occurs either during or
within hours of transfusion. The reaction usually manifests as hypoxia and noncardiogenic bilateral pulmonary oedema
progressing to respiratory failure. Patients are treated with oxygen, may require mechanical ventilation and usually
recover within a few days.
Below is a summary of the steps to follow ʹ as per ACS 1904 Procedural complications ʹ when coding transfusion
related acute lung injury:
ͻ Refer to the Alphabetic Index under the main term which best describes the complication, for the subterm procedural
or postprocedural:
For example - Oedema/lung ʹ no index option for (post)procedural
ͻ In some cases, rather than the generic term (post)procedural, the subterm may directly describe the procedure
involved:
For example - Oedema/lung ʹ no index option for (due to) transfusion
ͻ If there is no specific subterm for (post)procedural in the Alphabetic Index under the main term, follow the look up
for Complication(s), followed by the relevant body system to which the complication pertains and then
(post)procedural:
For example - Complication(s)/respiratory/postprocedural/specified NEC J95.8
ͻ The main term Complication(s) may also be followed by a subterm directly describing the type or nature of the
complication
For example - Complication(s)/transfusion/reaction NEC T80.8
The index pathway Complication(s)/transfusion/reaction leads to the assignment of T80.8 Other complications
following infusion, transfusion and therapeutic injection. This code provides greater specificity regarding the procedure
that caused the complication.
ͻ An additional code from Chapters 1 to 19 should be assigned where it provides further specificity
Therefore, where transfusion related acute lung injury (TRALI) is documented, assign:
T80.8 Other complications following infusion, transfusion and therapeutic injection
with an additional code for the manifestation (for example, noncardiogenic lung oedema) and appropriate external
cause codes, for example:
Y84.8 Other medical procedures by following the External Causes index pathway:
Complication (delayed) (medical or surgical procedure) (of or following) Y84.9
- with misadventure (see also Misadventure(s) to patient(s) during surgical or medical care) Y69
- transfusion
- - procedure Y84.8
OR
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Y69 Unspecified misadventure during surgical and medical care (if the complication occurred during the transfusion) by
following the External Causes index pathway:
Misadventure(s) to patient(s) during surgical or medical care Y69
͙
- transfusion (see also Misadventure(s) to patient(s) during surgical or medical care/by type/transfusion) Y69
And Y92.22 Health service area
(Coding Rules, June 2014)
Ref No: Q2846 | Published On: 15-Jun-2014 | Status: Current
Capsular contracture of breast implant
Q:
How do you code capsular contracture of a breast implant, where there is no documentation of infection or a
mechanical complication?
A:
Capsular contracture is a common and unavoidable complication of breast prosthesis implantation. Capsular
contracture occurs when the fibrous scar tissue that has formed around a breast implant shrinks and tightens, causing
distortion, firmness and pain.
Where there is documentation of capsular contracture of breast implant without further specification of cause, assign
T85.88 Other complications of internal prosthetic device, implant and graft NEC by following the index pathway:
Complications (from) (of)
͙- breast implant (prosthetic) T85.9
͙- - specified NEC T85.88
Where there is documentation that the complication was due to an infection or mechanical complication, assign a code
from T85 Complications of other internal prosthetic devices, implants and grafts by following the index pathways:
Complications (from) (of)
͙- breast implant (prosthetic) T85.9
- - infection or inflammation T85.78
- - mechanical T85.4
- - specified NEC T85.88
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2850 | Published On: 15-Jun-2014 | Status: Current
U73.8 Other specified activity
Q:
When should U73.8 Other specified activity be assigned?
A:
The index pathway Activity/specified NEC should be followed and U73.8 Other specified activity assigned when an
activity cannot be classified to any of these specified categories:

While engaged in sports or leisure (U50-U72):
 U50-U71 specified sports/leisure activities
 U72 Leisure activity, not elsewhere classified

While engaged in other activity (U73):
 U73.0 While working for income
 U73.1 While engaged in other types of work
 U73.2 While resting, sleeping, eating or engaging in other vital activities
Therefore, where an activity is specified but it is not listed under the lead term Activity and it cannot be classified to
any of the above categories, assign U73.8 Other specified activity.
Note that for the code range V00-V99 Transport accidents, where the activity at the time of the accident is not
specified as sport, leisure or working for an income, assign U73.9 Unspecified activity.
Note also that U72 Leisure activity, not elsewhere classified may be assigned for a wide range of activities that are not
classified as sport (U50-U71) or work (U73.0 and U73.1), for example, walking the dog.
For sexual intercourse NEC assign U73.2 While resting, sleeping, eating or engaging in other vital activities.
Amendments to ICD-10-AM Alphabetic Index will be considered for a future edition.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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Coding Rules
ACCD Classification Information Portal
Ref No: Q2852 | Published On: 15-Jun-2014 | Status: Current
Coronary artery vasospasm
Q:
How do you code vasospasm of the coronary arteries?
A:
Coronary artery vasospasm (Prinzmetal angina, vasoplastic angina, variant angina) may occur spontaneously or be
triggered by hyperventilation or by drug or tobacco use. Coronary artery vasospasm results in occlusion in either a
normal or diseased arterial segment and usually occurs at rest rather than as a consequence of physical exertion or
emotional stress.
Indexing of this condition is consistent with ICD-10. There is currently no subterm under the lead term Vasospasm for
coronary artery. Indexing amendments will be considered for a future edition of ICD-10-AM.
In the interim, where coronary artery vasospasm is documented, assign I20.1 Angina pectoris with documented spasm
by following the index pathway:
Spasm(s), spastic, spasticity
͙- coronary (artery) I20.1
References:
Nazir, S.A, Nazir, S., Kumar, S., and Ilsley, C. (2010) Multifocal severe coronary artery vasospasm mistaken for diffuse atherosclerosis: a case report. Case reports in medicine.
Volume 2010 (2010), Article ID 202156, 4 pages http://dx.doi.org/10.1155/2010/202156
Wang, S. (2012). Coronary Artery Vasospasm. Medscape. Retrieved from http://emedicine.medscape.com/article/153943-overview
(Coding Rules, June 2014)
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ACCD Classification Information Portal
Ref No: Q2857 | Published On: 15-Jun-2014 | Status: Current
Z06.67 Resistance to multiple antibiotics
Q:
Where there is documentation of resistance to two or more specified antibiotics and they are classified to the same
Z06 code, should you assign Z06.67?
A:
Amendments were made to Z06 Resistance to antimicrobial drugs for ICD-10-AM Eighth Edition following updates to
ICD-10.
Z06 contains subcategories (Z06.50 - Z06.58 and Z06.61 - Z06.63) for specific types of antibiotics.
Z06.68 Resistance to other single specified antibiotic classifies resistance to other types of antibiotics, including:
ͻ
ͻ
ͻ
ͻ
Tetracyclines (eg doxycycline)
Aminoglycosides (eg gentamicin, tobramycin)
Macrolides (eg erythromycin)
Sulfonamides (eg co-trimoxazole)
Z06.68 Resistance to other single specified antibiotic is assigned by following the index pathway:
Resistance
- antibiotic(s)
- - specified (single) Z06.68
Note that the term single is a nonessential modifier.
Z06.67 Resistance to multiple antibiotics should only be assigned as per the note:
Note: This code should only be assigned when an infectious agent is resistant to two or more antibiotics but the type of
antibiotics are not specified. Where multiple resistant antibiotics are specified, code each resistant antibiotic
separately.
When there is documentation of resistance to two or more antibiotics that are classified to the same Z06 code, the
specific code for the type of antibiotic should be assigned once, not Z06.67. For example, both gentamicin and
tobramycin are examples of aminoglycoside antibiotics. Therefore, where resistance to gentamicin and tobramycin is
documented, assign Z06.68 Resistance to other single specified antibiotic. Z06.67 should NOT be assigned as the type of
antibiotic has been specified.
Amendments to ICD-10-AM will be considered for a future edition to clarify the assignment of Z06.67.
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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ACCD Classification Information Portal
Ref No: Q2860 | Published On: 15-Jun-2014 | Status: Current
SUBJECT: Bronchial thermoplasty
Q:
How do you code bronchial thermoplasty?
A:
Bronchial thermoplasty (BT) is a relatively new procedure performed for the treatment of asthma. BT is performed by
the application of radiofrequency or thermal energy directly to the airway via a bronchoscope. The purpose of the
procedure is to reduce airway smooth muscle mass at the target areas in the bronchus.
The ACCD is currently reviewing ACHI Chapter 7 Procedures on Respiratory System, with particular reference to
bronchoscopic and destruction procedures, for a future edition.
In the interim, assign the following codes for bronchial thermoplasty:
90165-00 [547] Other procedures on bronchus
41898-00 [543] Fibreoptic bronchoscopy
References:
Castro, M., Musani, A., Mayse, M. and Shargill, N. (2010). Bronchial thermoplasty: a novel technique in the treatment of severe asthma. Therapeutic Advances in Respiratory
Disease 2010 4: 101 DOI: 10.1177/1753465810367505
Castro, M., Rubin, A., Laviolette, M., Fiterman, J., Lima, M., Shah, P., ͙Cox, G. (2010). Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma.
American Journal of Respiratory and Critical Care Medicine, 181(2), 116-124. doi: 10.1164/rccm.200903-0354OC
Department of Health and Ageing. Australian Safety and Efficacy Register of New Interventional Procedures ʹ Surgical (ASERNIPS). (2007). Bronchial thermoplasty for asthma.
Retrieved from http://www.horizonscanning.gov.au/internet/horizon/publishing.nsf/Content/E76BDEECDE7BD1A8CA2575AD0080F341/$File/PRIORITISING%20SUMMARY
%20-%20Bronchial%20Thermoplasty%20(12%20month%20update).pdf
Department of Health and Ageing. Australian Safety and Efficacy Register of New Interventional Procedures ʹ Surgical (ASERNIPS). (2007, Issue 4, September). Bronchial
thermoplasty for asthma ANZHSN Bulletin. Retrieved from
http://www.horizonscanning.gov.au/internet/horizon/publishing.nsf/Content/5190FF1EEFB296C4CA2575AD0080F33A/$File/4.%20ANZHSN%20Bulletin%20Sep%2007.pdf
(Coding Rules, June 2014)
Current as at 17-Jun-2014 05:15
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