WA Clinical Coding Advisory Group
Meeting date: 23rd January 2013 Meeting time: 9:00AM – 11:30AM
Attendees: Deborah Yagmich (Chair), Tracey Jamieson, Elise Groenewold, Bill Pyper, Anita Jacoby, Dragana Losic, Evans
Obaga (VC), Jodi Griffin, Justine Baggen, Kathryn Nicholls, Lisa Kerrigan (VC), Sharon Linton, Silvana Rossi
Apologies: Joan Knights, Julia Stone, Vana Savietto
Query
no.
Query Description
Proposed Decision
1
Coding of Chapter 20 codes
when performed under
anaesthesia. Should Chapter 20
codes always be coded when
performed under cerebral
anaesthesia or does the
anaesthesia need to have been
given for that specific procedure for
it to be coded?
Recommendation: ACS 0042 Procedures normally not coded states “the listed procedures should be coded if
cerebral anaesthesia is required in order for the procedure to be performed”.
A chapter 20 code should not be assigned when performed under cerebral anaesthesia, if it is performed in
conjunction with another procedure not excluded by ACS 0042.
Decision: A Chapter 20 code should not be assigned when performed under cerebral anaesthesia when it is
performed with another procedure performed during the same operative episode. This excludes where
Chapter 20 is mandated by ACS or WA Coding Committee decision:

59903-03 aortography see ACS 0933 Cardiac Catheterisation and Coronary Angiography

30668-00 endoscopic ultrasound (EUS) see WA Coding Committee item 8/05/2011.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
2
Faecal Microbiota
Transplantation I have a case
where a patient is treated for a 12
month history of recurrent
Clostridium difficile diarrhea as a
result of antibiotics. They have
been on Vancomycin for most of
the year with no resolution. There
is no mention of it being drug
resistant or drug induced. I have
coded it to: PDx A04.7. For the
Recommendation: Faecal microbiota transplantation is performed for recurrent C. difficile infections, when other
means of treatment have been exhausted. 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 nasoduodenal catheter,
colonoscope or retention enema catheter.
Coding depends on documentation of the method for the case. We recommend the use of the code 92075-00 [1895]
Gastrointestinal tract instillation, except gastric gavage for the actual transplantation procedure.
If a colonoscopy was performed, the relevant code for this should also be assigned, depending on extent.
Any anaesthetic performed should also be coded.
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WA Clinical Coding Advisory Group 23 January 2013
Query
no.
Query Description
procedures, do I just code the
colonoscopy? Is there a code to
capture the transplantation?
Proposed Decision
Decision: Faecal microbiota transplant should be coded to 92075-00 [1895] Gastrointestinal tract instillation,
except gastric gavage. Any other procedures performed at the same time such as method of delivery and
anaesthesia should also be coded.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
3
Injection into false aneurysm
What is the correct code for
thrombin injection into false
aneurysm? This involves simple
injection, percutaneous, not
transcatheter, of thrombin, into the
aneurysm. A previous decision
needs review. There is an index
listing ‘occlusion aneurysm’ which
leads to repair 33070 or 33142.
Recommendation: There was a previous decision by the WA Coding Committee in July 2009 – indexed under
thrombin injection into pseudo-aneurysm.
Query: I have a query regarding patients admitted for thrombin injection of false/pseudoaneursyms. The
patients are taken to radiology and thrombin is injected in the artery. The following are taken from two
radiology reports: "1000 units of Thrombin were instilled in to the most superficial aspect of the aneurysm
occluding approximately 50% of the volume of the aneurysm" "Using a sterile technique I injected 0.2ml of
Thrombin (200 units). A number of suggestions have been given for the procedure: 90223-01 Other vascular
procedures, 45027-01 Administration of agent into vascular anomaly: and 35321-07 Transcatheter
embolisation of blood vessels of limbs. The code for repair of aneurysm seems a little extreme! As the
patient is admitted specifically for this procedure I feel that it needs to be code - particularly if a same day
case. However if an overnight admission perhaps we don not need to code.
Decision: In the case you describe the thrombin (an agent that causes clotting) is injected percutaneous
and usually under ultrasound guidance into the pseudoaneurysm to clot the blood inside it. The clot is
gradually reabsorbed. A pseudoaneurysm can also be defined as a vascular anomaly, but the term usually
defines angiomas, haemangiomas and lymphagiomas. The procedure in this case is not performed via a
catheter so 35321-07 transcatheter embolisation would not be correct. The correct code would be as 4502701 administration of agent into vascular anomaly. Perhaps admissions for this procedure are questionable.
Recommendation: 45027-01 [742] Administration of agent into vascular anomaly is the correct code for
thrombin injection of pseudo-aneurysm.
The intent of the thrombin injection into the pseudo-aneurysm is to occlude the pseudo-aneurysm.
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WA Clinical Coding Advisory Group 23 January 2013
Query
no.
Query Description
Proposed Decision
The index pathway for arriving at 45027-01 [742] Administration of agent into vascular anomaly involves selecting
‘vascular anomaly’ which is not the same term as ‘aneurysm’ or pseudo-aneurysm’.
However by looking up occlusion, aneurysm the codes that are selected such as 33070-00 [714] Repair of aneurysm
in extremity or 33070-00 [714] Repair of aneurysm in extremity seem to be more invasive than the procedure actually
performed. Block 714 includes repair by: clipping, excision, ligation and suture which are more invasive terms than
injection.
We will refer this query to the NCCC for clarification and possible index update. In the interim we advise to follow the
previous WACC decision.
Decision: We will await a decision on this query from the NCCC. In the interim, follow the previous decision
made by the WACC. Assign 45027-01 [742] Administration of agent into vascular anomaly.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
4
Selective Internal Radiation
Spheres
What is the code for SIRS? (Y90
micropheres into the liver via
infusion into hepatic artery for liver
mets)
Recommendation: Yttrium 90 SIR sphere injection into the liver is a form of brachytherapy intended to embolise the
arteries around the malignancy. We recommend to code these cases to 15360-00 [1792] Brachytherapy,
intravascular and 35321-05 [768] Transcatheter embolisation of blood vessels, abdomen. If the SIR spheres are
administered to a site other than the liver, the appropriate embolisation code should be assigned.
16003-00 [1795] Administration of therapeutic dose of Yttrium 90 should not be assigned as this is for administration
of an unsealed radioisotope, rather than a sealed dose as in SIR spheres.
Decision: Injection of Y90 SIR spheres into the liver should be coded to 15360-00 [1792] Brachytherapy,
intravascular and 35321-05 [768] Transcatheter embolisation of blood vessels, abdomen.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
5
Injection of sclerosing agent into
bleeding oesophageal varices
When you use sclerotherapy as the
lead term there is no option to pick
Recommendation: To code injection of sclerosing agent into bleeding oesophageal varices use the look up
injection, sclerosing agent, bleeding, oesophageal. The correct code is 30478-06 [851] Endoscopic administration of
agent into bleeding lesion of oesophagus.
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WA Clinical Coding Advisory Group 23 January 2013
Query
no.
Query Description
bleeding or non-bleeding of
oesophageal varices and the
default code is non-bleeding. It is
the same for injection varices.
Proposed Decision
Decision: The correct code for injection of sclerosing agent into bleeding oesophageal varices is 30478-06
[851] Endoscopic administration of agent into bleeding lesion of oesophagus, using the look up injection,
sclerosing agent, bleeding, oesophageal. A proposal will be sent to the NCCC to update the indexing under
‘sclerotherapy’ and ‘injection, varices’.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
6
Transient bone marrow oedema
of hip
Please advise the correct
diagnosis code for transient bone
marrow oedema of the hip.
Recommendation: Clinical advice has been provided and transient bone marrow oedema is not a condition in its
own right. It is either a symptom of transient osteoporosis or avascular necrosis. Clarification from the treating
clinician should be sought for each case.
Decision: Transient bone marrow oedema is not a condition in its own right. It is either a symptom of
transient osteoporosis or avascular necrosis. Clarification from the treating clinician should be sought for
each case.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
7
Failed gastric band
How do you code failed gastric
band with vomiting and no weight
loss?
Recommendation: We are not able to provide an answer to this query. Documentation such as this should be
queried with the treating clinician. Clarification is required to determine if the symptom/condition is related to the
device. It does not need to be documented as causal but there needs to be an association.
Refer to ACS 1904 Procedural Complications page 254, “…when the complication relates to a prosthetic device,
implant or graft, look up the main term ‘complication’ and then by the device…”
Refer also to 8.7 Haemorrhage due to or associated with prosthetic devices, implants and grafts WA Coding
Committee decision date: 11/07/12.
Decision: Each case should be queried with the treating clinician for further clarification to determine if the
symptom/condition is related to the device.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
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WA Clinical Coding Advisory Group 23 January 2013
Query
no.
Query Description
Proposed Decision
8
Cerebral infarction I63 coded with
precerebral occlusion I65 and
cerebral occlusion I66
Recommendation: This previous instruction to double code the occlusion to show the specific site is not correct.
Blocks I65 and I66 state Occlusion and stenosis of cerebral/precerebral arteries, not resulting in cerebral infarction.
Block I63 contains codes for cerebral infarctions. This means that a code from I63 should not be coded with a code
from I65 or I66.
We have some advice from HDWA
from 1999 that states to code both
I63 and I65/I66 if both to show the
specific site of the occlusion. Can
we have some advice on if this is
still correct?
Decision: A code from block I65 or I66 should not be assigned with a code from block I63.
[WA Clinical Coding Advisory Group Decision Date: 23/01/2013]
5