Download September 2015 Coding Queries (PDF 235KB)

Queries discussed by
WA Clinical Coding Advisory Group
Meeting on 23rd September 2015
Attendees: Elise Groenewold, Dragana Losic, Brooke Holroyd, Anita Jacoby, Rosi Katich, Bill Pyper, Vana Savietto, Tracy Briggs,
Deb Yagmich, Wilhelmina Blocher, Jennifer Vardy.
Apologies: Brian Stanley, Tonia Brockman, Sharon Linton, Dimity Mutton, Silvana Rossi.
Query no.
Query Description
Decision
1
Dementia in Alzheimer’s
disease
If a patient has Alzheimer’s
dementia and another type of
dementia, should you code two
dementia codes (i.e. G30.9,
F00.9, F01.x) or code to
G30.8† and F00.2* Dementia
in Alzheimer’s disease,
atypical or mixed type?
Recommendation:
Dementia in Alzheimer’s disease may be present with another type of dementia such as vascular dementia.
Following the Index pathway for dementia in Alzheimer’s disease, there is an option to select ‘atypical or mixed’. This
should only be selected if there is documentation of one of the terms ‘atypical’ or ‘mixed’ dementia. Selecting this option
when there is another type of dementia documented, such as vascular dementia, will result in this specificity being lost in
the final coding.
The correct codes to assign for dementia in Alzheimer’s disease and vascular dementia are:
G30.9 Alzheimer’s disease, unspecified
F00.9 Dementia in Alzheimer’s disease, unspecified
F01.x Vascular dementia
Decision: Coders should follow the Index pathways when coding dementia in Alzheimer’s disease with another type of
dementia. Both types may be coded out separately to adequately transcribe the diagnostic statement into code.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
2
Transverse upper segment
caesarean section
How should a transverse
upper segment caesarean
Recommendation: Occasionally, a transverse incision in the upper segment of the uterus is used to perform a caesarean
section when there is a transverse lie or a contraction ring.
Clinical advice indicates that the best code for a transverse upper segment caesarean is a classical caesarean section.
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Query no.
Query Description
Decision
section be coded? Should it be
coded to a classical
caesarean?
Decision: A transverse upper segment caesarean section should be coded to 16520-00 [1340] Elective classical
caesarean section or 16520-01 [1340] Emergency classical caesarean section.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
3
Subcutaneous ICD lead
insertion
Which code should be
assigned for insertion of a
subcutaneous ICD lead?
There is no Index entry for this
type of lead in ACHI.
Recommendation: Insertion of a subcutaneous lead for an ICD involves tunnelling the lead from the generator pocket
under the armpit to the sternal area. There is currently no Index entry for insertion of a subcutaneous ICD lead in ACHI. As
this procedure is much less invasive than a traditional transvenous or epicardial lead insertion, it can be considered a
component of the procedure of ICD insertion. Absence of a specific lead insertion code would indicate subcutaneous lead
insertion.
Decision: Insertion of a subcutaneous lead with insertion of an ICD does not require a procedure code. It is inherent in
the ICD insertion procedure code. This query will be forwarded on to the ACCD for consideration of an Index entry in
future editions of ACHI.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
4
Cancelled infusion
How should a cancelled
infusion, dialysis or transfusion
be coded if the patient is
already sitting in the chair
where the infusion is to take
place? Looking at the flowchart
in the WA Coding Standards,
the patient is already in the
‘theatre or similar’.
Recommendation: For the purposes of the WA Coding Standards, ‘theatre or similar’ should be interpreted as the place
where the procedure is to take place EXCEPT in the case of infusions, dialysis and transfusions. For these cases, there
has been no utilisation of theatre (or similar) time, which is the rationale behind asking whether the patient is already in
theatre. For a cancelled infusion, dialysis or transfusion to be coded as an inpatient episode of care, the infusion, dialysis
or transfusion must have already commenced (see box 3 in the flowchart).
This will be clarified in the next version of the WA Coding Standards.
Decision: For the purposes of the WA Coding Standards, ‘theatre or similar’ should be interpreted as the place where the
procedure is to take place (e.g. theatre, cath lab, radiology, endoscopy procedural room etc), EXCEPT in the case of
infusions, dialysis and transfusions.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
5
Insertion, removal and
exchange of silicone oil with
laser repair of retinal
detachment
Should insertion, removal or
exchange of silicone oil be
Recommendation: Silicone oil may be used to replace vitreous fluid for retinal tamponade during repair of retinal
detachment. It is most commonly used in cases of complicated retinal detachment.
Clinical advice states that insertion, removal and exchange of silicone oil are inherent in all procedures for repair of retinal
detachment.
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Query no.
Query Description
Decision
coded separately when repair
of retinal detachment is
performed?
Decision: Insertion, removal and exchange of silicone oil are inherent in all procedures for repair of retinal detachment. A
separate procedure code does not need to be assigned.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
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Retinectomy
What is the correct code to
assign for retinectomy? It was
performed with repair of retinal
detachment.
Recommendation: A retinectomy is usually performed for repair of severe retinal detachment complicated by proliferative
vitreoretinopathy. It involves excising a part of the retina and is performed as an alternative to scleral buckling.
Clinical advice is to assign a separate procedure code for retinectomy. As no Index pathway exists in ACHI for
retinectomy, the best code to assign is 90079-00 [212] Other repair of retinal detachment.
Decision: Retinectomy for repair of retinal detachment should be coded to 90079-00 [212] Other repair of retinal
detachment.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
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Incision and drainage of
abscess with curettage
How should I&D of an
abscess, with curettage be
coded?
Recommendation: There is no Index entry in ACHI for incision and drainage of an abscess with curettage. Using the lead
term of ‘curettage’, there is no entry for ‘abscess’. No other options in this Index pathway are suitable. Assignment of other
procedure codes would require use of lead terms and essential modifiers that have not been documented.
It is unclear whether curettage is inherent in an incision and drainage of abscess code, or whether it is a significant
additional procedure and so requires a specific code.
Decision: This query will be sent to the ACCD for clarification. In the interim, coders should only assign 30223-01 [1606]
Incision and drainage of abscess of skin and subcutaneous tissue for documentation of incision and drainage of an
abscess with curettage.
[WA Clinical Coding Advisory Group Decision Date: 23/09/2015]
WA advice replaced by ACCD advice
1
Metabolic acidosis in a
diabetes mellitus patient
Q: What is the correct code assignment for metabolic acidosis in a patient with diabetes mellitus?
A: Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid
from the body. The different types of metabolic acidosis are:

Diabetic acidosis (also called diabetic ketoacidosis and DKA) which develops when acidic substances known as
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Query no.
Query Description
Decision
ketone bodies build up in the body. This commonly occurs with uncontrolled type 1 diabetes mellitus but can occur
with type 2 diabetes mellitus.

Hyperchloraemic acidosis which results from excessive loss of sodium bicarbonate from the body. This can occur
with severe diarrhoea.

Lactic acidosis results from a buildup of lactic acid. It can be caused by alcohol, diabetes, cancer, exercising
intensely, liver failure, medications, such as salicylates, prolonged lack of oxygen from shock, heart failure, severe
anaemia and seizures.
Other causes of metabolic acidosis include:
 Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis)
 Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol
 Severe dehydration
(National Institute of Health, 2013).
ICD-10-AM does not assume a causal link between diabetes mellitus and metabolic acidosis NOS when both are
documented. However, it does assume a causal link where there is documentation of lactic acidosis or ketoacidosis as per
the index pathway below:
Diabetes, diabetic
- with
- - acidosis — see also Diabetes/with/ketoacidosis
- - - lactic (without coma) E1-.13
- - - - with coma E1-.14
- - - - and ketoacidosis (without coma) E1-.15
- - - - - with coma E1-.16
Clarification should be sought from the treating clinician as to the specific type of metabolic acidosis to assign E1-.13 –
E1-.16. When clarification is not possible, assign E87.2 Acidosis following the index pathway:
Acidosis (lactic) (respiratory) E87.2
- diabetic — see Diabetes/with/acidosis
- metabolic NEC E87.2
Improvements to ICD-10-AM Alphabetic Index will be considered for a future edition.
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Query no.
Query Description
Decision
[ACCD Coding Rules, October 2015]
2
Injection of botulinum toxin
(Botox) for manifestations of
cerebral palsy
Q: What is the principal diagnosis for a patient with manifestations of cerebral palsy admitted for injection of Botox?
A:
Cerebral palsy (CP) describes a group of disorders associated with movement and posture that are attributed to nonprogressive disturbances that occurred in the developing brain. It occurs in about two per 1000 live births.
There are four main types of cerebral palsy:




Spastic CP is the most common type, characterised by stiffness or tightness of the muscles, which is most
obvious when the person tries to move.
Athetoid CP is characterised by uncontrolled movements and often leads to erratic movements.
Ataxic CP is the least common type of cerebral palsy and is characterised by a lack of balance and coordination. It
often presents as unsteady, shaky movements or tremors.
Mixed CP may involve a combination of types of cerebral palsy.
Muscle spasms, spastic movements, spasticity and other muscular related features such as muscle contracture and
excessive drooling are characteristic of some types of CP and are classified by the type of cerebral palsy at G80.Cerebral palsy. Therefore, do not assign additional codes such as R25.2 Cramp and spasm when one of these features is
documented as the indication for the episode of care (eg injection of botulinum toxin). That is, where documentation
indicates that the patient has CP and the admission is for injection of botulinum toxin for spasticity (eg focal spasticity,
muscle spasticity), assign a code from G80.- Cerebral palsy, by following the index pathway:
Palsy
- cerebral
[ACCD Coding Rules, October 2015]
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continued
Query no.
Query Description
Decision
3
Vascular closure devices
Q:
Should an ACHI code be assigned when Angio-seal™ (or another vascular closure device) is used following an arterial
catheterisation?
A:
Angio-seal™ is a brand of vascular closure device deployed following arterial catheterisation procedures. The purpose of
the device is to achieve haemostasis by creating a mechanical seal at the arteriotomy site (that is, the puncture site in the
artery used for access of the catheter – usually the femoral artery).
It is not necessary to assign a procedure code for use of a vascular closure device, as it is an inherent part of a
catheterisation procedure, as per the guidelines in ACS 0016 General procedure guidelines/Procedure components:
Do not code procedures which are individual components of another procedure. These components would usually
be considered a routine or inherent part of the more significant procedure being performed.
[ACCD Coding Rules, October 2015]
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Query no.
Query Description
Decision
4
Os acromiale
Q:
What is the correct code to assign for os acromiale?
A:
The acromial process of the scapula begins as separate osseous centres, which gradually fuse. The fusion process
begins around age 15, and is normally complete by age 25. Os acromiale is a developmental disorder in which there is
failure of fusion of these osseous centres of the scapula, resulting in the acromion being joined to the scapular spine by
fibrous tissue rather than by bony union. The disorder may be completely painless and symptom free, but may also be
associated with shoulder impingement, and rotator cuff pathology.
Assign M89.21, Other disorders of bone development and growth, shoulder region, for os acromiale by following the index
pathway:
Disorder (of)
- bone
- - development and growth NEC M89.2with fifth character: 1 shoulder region
Indexing improvements will be considered for a future edition of ICD-10-AM.
[ACCD Coding Rules, October 2015]
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