Download Coding Rules - Current as at 16-Jun

Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3033 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Endoscopic drainage (fenestration) of
craniopharyngioma
Q:
What is the correct code to assign for endoscopic fenestration (drainage) of a craniopharyngioma cyst?
A:
A craniopharyngioma is a benign tumour with malignant behaviour that arises most frequently in the
pituitary stalk and projects into the hypothalamus. It is a tumour that has both solid and cystic components.
ACHI classifies removal of craniopharyngioma to 39712-02 Removal of craniopharyngioma in block [125]
Other excision procedures on pituitary gland. However there is no specific code when the treatment is
aimed at alleviating the symptomatic effect of the tumour on surrounding structures by fenestration of the
cystic component; and where the solid component is not removed.
For endoscopic fenestration of a craniopharyngioma cyst assign 39703-01 [8] Drainage of intracranial lesion
or cyst by following the Alphabetic Index:
Drainage
- intracranial (via burr holes) 39703-01 [8]
- - lesion 39703-01 [8]
or
Drainage
- intracranial (via burr holes) 39703-01 [8]
- - tumour 39703-01 [8]
As this was an endoscopic procedure, also assign 40903-00 [1] Neuroendoscopy as per ACS 0023
Laparoscopic/arthroscopic/endoscopic surgery.
Improvements to this area of the classification will be considered for a future edition of ACHI.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 1 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2903 | Published On: 15-Jun-2016 | Status: Current | Supersedes: Q2728
SUBJECT: Diagnosis code assignment for admission for insulin
pump
Q:
What is the correct principal diagnosis to assign when a patient with diabetes mellitus is admitted for
connection of an insulin pump?
A:
Where adjustment, management, fitting or removal of the insulin pump is the principal reason for the
admission (ie it meets the criteria for assignment as per ACS 0001 Principal diagnosis), the correct code to
assign is Z45.1 Adjustment and management of drug delivery device followed by the appropriate code(s) for
diabetes mellitus.
For classification advice related to ACHI codes for insulin pumps, refer to Coding Rule Insulin pumps.
Amendments to the classification will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 2 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2953 | Published On: 15-Jun-2016 | Status: Current | Supersedes: TN565
SUBJECT: High flow therapy
Q:
What is the correct code to assign for high flow therapy when administered via nasal cannula or
tracheostomy?
A:
High flow therapy (HFT), also known as high flow nasal cannula (HFNC) or high flow nasal prongs (HFNP), is
a type of respiratory support introduced as an alternative to noninvasive ventilation (NIV). HFT is more than
simple oxygen enrichment or humidification as it involves the administration of ventilatory support,
therefore in ACHI HFT is classified as noninvasive ventilatory support.
High flow therapy devices, unlike conventional oxygen administration or NIV, use a system of heated
humidification and large-bore nasal prongs to deliver oxygen at flows of up to 50-60 L/minute. This is
usually used in conjunction with an oxygen blender, allowing delivery of precise inspired oxygen
concentrations.
HFT is used on patients ranging in ages from preterm infants to adults who receive flow rates for
respiratory support in a variety of conditions, such as:
• Newborns: used in the management of respiratory distress or apnoea and weaning from invasive forms
of respiratory support. HFT is generally administered at 2-7 L/minute for neonate
• Paediatrics: used in conditions such as viral bronchiolitis, bacterial pneumonia and reactive airway
disease. HFT is generally administered at 4-12 L/minute for infants and young children
• Adults: used in a variety of clinical care settings for patients with conditions such as type 1 (hypoxic)
respiratory failure, pulmonary oedema, chronic obstructive pulmonary disease (COPD) and acute
respiratory distress syndrome (ARDS). HFT is generally administered at 20-40 L/minute for adults.
HFT can also be delivered through a tracheostomy with an entrainment device.
Despite the similar description, high flow oxygen (or humidified oxygen) is not the same as high flow
therapy. HFT depends on the device being able to generate a sufficient pressure gradient to improve
oxygenation. While the required pressure can be generated through a nasal cannula (prongs), it cannot be
produced with a face mask. Therefore, despite the modalities listed for NIV in ACS 1006 Ventilatory
support, including mask, high flow oxygen must be delivered through a nasal cannula (prongs) or
tracheostomy to be considered as high flow therapy and coded as noninvasive ventilation.
Clinical coders should assign high flow therapy based on clinical documentation and not on the basis of the
delivery flow rates alone. Clinical documentation must be clear that high flow therapy is being provided (ie,
high flow oxygen administered via nasal cannula/prongs or tracheostomy). If high flow is documented
without being administered via these techniques, clinical coders should verify with the clinician whether it
is HFT before classifying as NIV.
When HFT is documented in the clinical record, assign an appropriate code from block [570] Noninvasive
ventilatory support following the lead terms:
HFNC (high flow nasal cannula) (heated) (humidified) — see block [570]
HFT (high flow therapy) (heated) (humidified) — see block [570]
High flow nasal cannula (HFNC) (heated) (humidified) — see block [570]
Coding Rules - Current as at 16-Jun-2016 03:50
Page 3 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Therapy
- high flow (heated) (HFT) (humidified) (nasal) — see block [570]
Where high flow therapy is delivered via a tracheostomy, follow the Excludes note at block [570]
Noninvasive ventilatory support to assign a code from block [569] Ventilatory support.
Improvements to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 4 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2987 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Adverse effect of Champix (varenicline)
Q:
What is the correct external cause code to assign for adverse effect of Champix (varenicline) in therapeutic
use?
A:
Champix (varenicline) belongs to the class of medications called smoking cessation therapies. It is used to
help people quit smoking when nicotine replacement therapy has not been effective. Varenicline works in
the brain to reduce cravings and withdrawal symptoms. It also decreases the pleasure that people derive
from smoking and is thought to produce these effects by acting on the same receptors in the brain as
nicotine in cigarettes.
ICD-10-AM does not have a specific code for adverse effect of varenicline (Champix) in therapeutic use.
Assign Y57.8 Other drugs and medicaments by selecting Nicotine/medicinal, Adverse effect in therapeutic
use in the Table of Drugs and Chemicals.
Improvement to the ICD-10-AM Alphabetic Index, Table of Drugs and Chemicals will be considered for a
future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 5 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2992 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Leg ulcer due to venous insufficiency
Q:
Index entries for leg ulcer due to venous insufficiency lead to I87.2 Venous insufficiency, which does not
reflect that the patient has a leg ulcer. Can an appropriate code from category L97 Ulcer of lower limb, not
elsewhere classified also be assigned to reflect the episode of care?
A:
Included in the response below is reference to a 9th Edition code (L97.9). However, the response provided
is applicable to current 8th Edition coding practice, code assignment will be L97.
The indexing for leg ulcer due to venous insufficiency is from ICD-10 and supports mortality coding ie
coding of the underlying cause (aetiology). However, for the purpose of morbidity coding, apply ACS 0001
Principal diagnosis, problems and underlying conditions, point 2. Coding the problem as the principal
diagnosis which supports the assignment of the problem (limb ulcer) and underlying cause (venous
insufficiency).
Therefore, to classify a leg ulcer (without further specification) due to venous insufficiency, assign L97.9
Ulcer of lower limb, unspecified and I87.2 Venous insufficiency (chronic) (peripheral) as per ACS 0001
Principal diagnosis, problems and underlying conditions, point 2.
Note: This advice should not be used as a precedent to ignore other index entries without confirmation
from ACCD.
Amendments to ICD-10-AM Alphabetic Index will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 6 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2994 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Intramuscular sedation for anaesthesia
Q:
Should sedation administered intramuscularly (IM) be coded (eg a paediatric patient with a fractured radius
reduced under IM sedation)?
A:
Intramuscular (IM) sedation is given where rapid onset/short term anaesthesia is required, without a full
general anaesthetic effect (ie without loss of respiratory drive or protective airway tone). This is often
administered in paediatric patients, or other patients who require sedation to evaluate and treat their
injuries whilst limiting distress. IM sedation is used to facilitate patient cooperation during imaging studies
or during painful procedures such as fracture reductions, abscess incision and drainage, lumbar puncture,
or complex laceration repairs (Madati 2011).
ACS 0031 Anaesthesia instructs that sedation may be assigned where anaesthetic is administered as per
general anaesthesia (intravenous or inhalational or both) and there is no documentation of the use of an
artificial airway. It also instructs that oral sedation is not to be coded, however there is no instruction
regarding intramuscular sedation.
Given the increasing use of sedation administered intramuscularly 92515-XX [1910] Sedation is to be
assigned for intramuscular sedation, when administered for anaesthetic effect.
Consideration will be given to updating ACS 0031 Anaesthesia to include instruction for the use of
intramuscular sedation for a future edition of the ACS.
Reference:
Madati PJ 2011, ‘Ketamine: Procedural Pediatric Sedation In The Emergency Department’, EB Medicine Pediatric Emergency
Medicine Practice (Journal), vol. 8, no.1, viewed 15 February 2016,
https://www.ebmedicine.net/topics.php?paction=showTopictopic_id=247
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 7 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q2999 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Implantation of bone conduction hearing devices
Q:
What codes should be assigned for implantation of bone conduction hearing devices?
A:
A bone conduction hearing aid consists of a hearing aid worn behind the ear coupled with an
electromagnetic bone conductor/vibrator. These devices are not bone anchored.
Bone conduction aids may be the best option for children who cannot wear a conventional aid due to the
following:
• ear/s have not developed normally and parts of the outer or middle ear are missing or too small to fit
the device,
• constantly discharging ears,
• severe irritation or inflammation in the external canal.
A bone conduction hearing aid is classified to 41557-02 [321] Implantation of electromagnetic hearing
device by following the Alphabetic Index:
Insertion
- hearing device
- - bone conduction 41557-02 [321]
…
- - electromagnetic 41557-02 [321]
The bone anchored hearing aid or ‘BAHA’ system utilises a titanium implant which is placed in the skull
bone behind the non-functioning ear. An abutment connects the sound processor with the implant in the
bone. This creates direct (percutaneous) bone conduction.
BAHA may be performed as a one stage or two stage surgery. This decision is based on several factors
including the thickness and quality of the cortical bone as well as the patient’s age. Generally, for patients
with good bone quality and thickness greater than 3 mm, surgery in a single operative episode is
recommended. However, in patients with compromised or soft bone, irradiated bone, bone thickness less
than 3 mm, special needs patients (e.g. mentally or physically compromised) or in conjunction with other
surgery (e.g. acoustic neuroma removal) two stages is generally recommended.
As per ACS 1220 Extraoral osseointegrated implants:
Stage one BAHA surgery is classified to 45794-00 [1698] Osseointegration procedure, implantation of
titanium fixture for attachment of bone anchored hearing aid [BAHA] by following the Alphabetic Index:
Osseointegration
- extraoral
- - implantation of titanium fixture (1st stage)
- - - for
- - - - attachment of
- - - - - bone anchored hearing aid (BAHA) 45794-00 [1698]
Coding Rules - Current as at 16-Jun-2016 03:50
Page 8 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Stage two BAHA surgery is classified to 45797-00 [1697] Osseointegration procedure, fixation of
transcutaneous abutment for attachment of bone anchored hearing aid [BAHA] by following the Alphabetic
Index:
Osseointegration
- extraoral
- - fixation of transcutaneous abutment (2nd stage)
- - - for attachment of
- - - - bone anchored hearing aid (BAHA) 45797-00 [1697]
Where both ‘stages’ of the BAHA are completed in one operative visit assign both codes. Do not assign
41557-02 [321] Implantation of electromagnetic hearing device with BAHA surgery.
Clinical coders should be guided by the entire operation report, not abbreviations or brand names.
Improvements to the classification of bone conduction and bone anchored hearing aids will be considered
for a future edition of ACHI.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 9 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3000 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Endotracheal administration of surfactant
Q:
Should endotracheal intubation be assigned when surfactants, such as Curosurf, are administered via an
endotracheal tube?
A:
Curosurf is a natural surfactant, prepared from porcine lungs and used in the treatment of respiratory
distress syndrome (RDS) in premature babies. Surfactants are wetting agents that coat the surface of the air
sacs (alveoli) and reduce surface tension in the lungs which assists the air sacs to inflate and expand during
breathing and stops them sticking together. Administration of surfactants helps premature neonates
breathe until their lungs have developed enough to produce their own surfactant.
Surfactants, such as Curosurf, may be given directly into the lungs via an endotracheal tube in a ventilated
neonate, or administered prophylactically through an endotracheal tube without ventilation.
ACS 1614 Respiratory distress syndrome/hyaline membrane disease/surfactant deficiency states:
Surfactant is administered routinely for the treatment of respiratory distress syndrome of the newborn and
should not be coded (see ACS 0042 Procedures normally not coded, point 8).
Endotracheal intubation as the route of administration for a surfactant is not coded unless it proceeds to
ventilation.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 10 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3001 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Incision and drainage of abscess with curettage
Q:
When curettage is performed with an incision and drainage of an abscess, should this be coded to
excisional debridement?
A:
During incision and drainage of an abscess, a curette may be used to remove slough and/or debris from the
abscess cavity. This is a component of the procedure and does not require an additional code as per the
guidelines in ACS 0016 General procedure guidelines/Procedure components.
The correct code to assign for incision and drainage of an abscess with or without curettage is 30223-01
[1606] Incision and drainage of abscess of skin and subcutaneous tissue, following the lead terms Drainage
or Incision.
Amendments to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 11 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3013 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Cardiac pacemaker and implanted defibrillator status
Q:
When should the pacemaker status code Z95.0 Presence of cardiac device be assigned?
A:
Medical equipment and devices which emit electromagnetic interference (EMI) can inhibit pulse generators
and pacemakers causing damage to the circuits of the device and placing a patient at risk, so monitoring of
the pacemaker function is essential during these procedures. The risk of EMI is high for some procedures,
such as monopolar electrocautery.
ACS 0016 General procedure guidelines states:
A procedure is defined as “a clinical intervention represented by a code that:





is surgical in nature, and/or
carries a procedural risk, and/or
carries an anaesthetic risk, and/or
requires specialised training, and/or
requires special facilities or equipment only available in an acute care setting”
(METeOR 514040) (Australian Institute of Health and Welfare 2014)
ACS 0936 Cardiac pacemakers and implanted defibrillators states:
Patients with a pacemaker or defibrillator in situ require additional care at the time of procedural
interventions, and therefore Z95.0 Presence of cardiac device should be coded for all procedural cases.
Z95.0 Presence of cardiac device is assigned as an additional diagnosis for those patients who have a
pacemaker or implanted defibrillator in situ and who undergo a procedure that meets the definition of a
procedural intervention as per ACS 0016 General procedure guidelines.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 12 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3018 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Neonatorum in the Alphabetic Index
Q:
When is it appropriate to follow the entries in the Alphabetic Index with a subterm ‘neonatorum’?
A:
The term neonatorum is synonymous with neonatal. A condition so described indicates it is arising in the
neonatal period, for example polycythaemia neonatorum, urticaria neonatorum, ophthalmia neonatorum.
Therefore, it is appropriate to use the subterm neonatorum in the ICD-10-AM Alphabetic Index to classify
conditions in a neonate or arising in the neonatal period.
Amendments to the classification will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 13 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Ref No: Q3019 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Neuropathic pain
Q:
What is the correct code to assign for neuropathic pain?
A:
Neuropathic pain is a type of chronic pain caused by a lesion or disorder of the nervous system (e.g.
multiple sclerosis). It typically presents as generalised pain.
ICD-10-AM does not have a specific code or Alphabetic Index entry for neuropathic pain.
It is incorrect to follow the Alphabetic Index Pain/nerve NEC to assign M79.2- Neuralgia and neuritis,
unspecified or Neuropathy, neuropathic to assign G62.9 Polyneuropathy, unspecified.
Where neuropathic pain is documented assign R52.2 Other chronic pain following the Alphabetic Index:
Pain(s)
- chronic
- - specified R52.2
If neuropathic pain is documented as localised e.g. neuropathic pain of leg, follow the guidelines in ACS
1807 Pain diagnoses and pain management procedures, Chronic/intractable pain and code the site of the
pain.
The classification of chronic pain is currently under review for ICD-10-AM Tenth Edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 14 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3028 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Labile diabetes
Q:
Can labile diabetes mellitus be assigned to unstable diabetes mellitus?
A:
In the context of diabetes mellitus the term labile is used to describe wide, recurrent fluctuations in blood
glucose levels. Synonymous terms include unstable or brittle diabetes.
While unstable diabetes may be associated with any form of diabetes mellitus, brittle diabetes is associated
specifically with E10 Type 1 diabetes mellitus as listed in the Includes note.
Where labile diabetes is documented assign E1-.65 * diabetes mellitus with poor control following the
Alphabetic Index:
Diabetes, diabetic
- unstable E1-.65
Updates to ICD-10-AM will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 15 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3030 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Intra-tympanic dexamethasone (IT dexa)
Q:
What is the appropriate code for intra-tympanic administration of dexamethasone or other
pharmacological agent?
A:
Intra-tympanic (IT) administration of pharmacological agents such as dexamethasone and gentamicin are
used in the treatment of inner ear disorders such as Meniere’s disease and autoimmune or sensorineural
hearing loss.
Administration is a simple injection via myringotomy, tympanostomy tube or microwick, which delivers the
pharmacological agent directly to the middle ear (round window membrane).
For IT administration of pharmacological agents to the middle ear (round window membrane) assign
90114-00 [316] Other procedures on eardrum or middle ear following the Alphabetic Index:
Procedure
- ear
- - middle NEC 90114-00 [316]
Amendments to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 16 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3035 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Turbinoplasty
Q:
What is the correct code to assign for a turbinoplasty?
A:
During a turbinoplasty, the turbinates are reshaped either by outfracturing or submucosal resection or a
combination of the two methods. Both involve removal of turbinate tissue (ie a partial turbinectomy) via
different mechanisms.
ACHI does not have a specific code for turbinoplasty, therefore assign code(s) according to the
documentation within the operation report:
• 41692-00 [376] Submucous resection of turbinate, unilateral
• 41692-01 [376] Submucous resection of turbinate, bilateral
• 41686-00 [381] Surgical fracture of nasal turbinates, unilateral
• 41686-01 [381] Surgical fracture of nasal turbinates, bilateral
•
41689-00 [376] Partial turbinectomy, unilateral
• 41689-01 [376] Partial turbinectomy, bilateral
If outfracturing (surgical fracture) or submucous resection is not specified assign 41689-00 [376] Partial
turbinectomy, unilateral or 41689-01 [376] Partial turbinectomy, bilateral following the Alphabetic Index:
Turbinectomy
- partial (unilateral) 41689-00 [376]
- - bilateral 41689-01 [376]
However, if a turbinoplasty (by any method) is performed in conjunction with a septoplasty assign 4167102 [379] Septoplasty or 41671-03 [379] Septoplasty with submucous resection of nasal septum; as
turbinectomy is included within these codes as per the Includes notes.
Amendments to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 17 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3036 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Mittendorf dot
Q:
What is the correct code to assign for a Mittendorf dot?
A:
A Mittendorf dot is a small, circular opacity on the posterior lens capsule, classically nasal in location, which
represents the anterior attachment of the hyaloid artery. The hyaloid artery is present during gestation and
typically regresses completely. Failure to do so results in an embryonic remnant of the hyaloid artery (also
described as a persistent hyaloid artery) and to benign findings, such as a Mittendorf dot (Weed, 2013).
The correct code to assign for a Mittendorf dot is Q14.0 Congenital malformation of vitreous humour
following the Alphabetic Index:
Persistence, persistent (congenital)
- hyaloid
- - artery (generally incomplete) Q14.0
Improvements to ICD-10-AM will be considered for a future edition.
References:
Weed, M 2013, Mittendorf dot, University of Iowa Healthcare, Ophthalmology and Visuals Sciences, viewed 15 February 2016,
http://www.eyerounds.org/atlas/pages/mittendorf-dots.htm
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 18 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3041 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: External fixation using pins or wires
Q:
When external fixation using pins or wires is documented should this be coded as external fixation or
internal fixation?
A:
Application of external fixation devices (including those involving pins and wires but not involving
correction of limb deformity, fracture reduction, limb lengthening, mandible, maxilla or pelvis surgery) are
classified in ACHI to 50130-00 [1550] Application of external fixation device, not elsewhere classified as
clarified in the Note at this code which states:
This code classifies external fixation devices, not classified elsewhere, that are invasive (ie applied to bone).
External fixation devices that are noninvasive are classified elsewhere.
Follow the Alphabetic Index:
Fixation
- bone
- - external (invasive) 50130-00 [1550]
Amendments to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 19 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3042 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Excision of umbilicus
Q:
What is the correct code to assign for excision of the umbilicus?
A:
As ACHI classifies other procedures on the umbilicus to the Abdomen, Peritoneum and Omentum assign
90331-00 [1004] Other procedures on abdomen, peritoneum or omentum following the Alphabetic Index:
Procedure
- abdomen NEC 90331-00 [1004]
Amendments for excision of umbilicus will be considered for a future edition of ACHI.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 20 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3046 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Kennedy terminal ulcer
Q:
How should Kennedy terminal ulcer (Kennedy ulcer) be coded? Should it be classified as a pressure injury or
as an ulcer?
A:
A Kennedy terminal ulcer (KTU), or Kennedy ulcer, is a type of pressure injury (ulcer) that occurs in patients
in the terminal stage of life. Although a Kennedy ulcer may have a different shape to other pressure ulcers
and may progress rapidly from superficial to deep, their management is the same as any other pressure
injury (ulcer).
Where clinical documentation identifies a Kennedy terminal ulcer, assign an appropriate code from
category L89 Pressure injury.
Improvements to the classification will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 21 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3048 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Facetectomy
Q:
What is the correct code to assign for facetectomy, eg lumbar 4/5 medial facetectomy?
A:
Medial facetectomy is a procedure that partially removes one or both facet joints of the vertebrae. The
procedure decompresses the spinal nerves being pinched by degenerated facet joints (Philips, 2016).
While there is no index entry for facetectomy in ACHI the correct code to assign is 40330-00 [49] Spinal
rhizolysis following the Alphabetic Index:
Decompression
- spinal
- - nerve roots (rhizolysis) 40330-00 [49]
Amendments to the ACHI Alphabetic Index will be considered for a future edition.
References:
Philips M 2016, The Brain and Spine Center, Southcoast Hospitals Group, Dartmouth, Massachusetts, “Medial Facetectomy’, viewed
25 February 2016, http://www.spines.com/procedures/medial-facetectomy
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 22 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3049 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Vascularised Lymph Node Transfer
Q:
What procedure code should be assigned for vascularised lymph node transfer?
A:
Vascularised lymph node transfer (VLNT) is a procedure where lymph nodes are transferred as a standalone block of tissue, harvested commonly from the groin, but can be from other lymph node areas. The
blood supply to the transplanted lymph nodes is connected to local blood vessels in the recipient site
(usually the axilla, wrist or antecubital area) as part of the transfer.
There is no specific code in ACHI for VLNT, therefore assign 90283-00 [812] Other procedures on lymphatic
structures following the Alphabetic Index:
Transplant, transplantation
- lymphatic structure(s) (peripheral) 90283-00 [812]
As microvascular anastomosis is inherent in a vascularised lymph node transfer, it is unnecessary to assign a
separate code for the microsurgical anastomosis as per the guidelines in ACS 0016 General procedure
guidelines, Procedure components.
Improvements to the classification will be considered for a future edition of ACHI.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 23 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3050 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Lipiodol (poppy seed oil) tubal flushing
Q:
What procedure code should be assigned for Lipiodol flush?
A:
Lipiodol tubal flushing is a procedure that bathes the fallopian tubes (and uterus) in Lipiodol (poppy seed
oil) (Repromed 2016).
Several theories exist on how Lipiodol is thought to enhance pregnancy rates, including flushing of nonocclusive but pregnancy-hindering debris from fallopian tubes; positively influencing the intraperitoneal
environment; improving either the environment in which eggs mature or the sperm-egg interaction; or by
enhancing implantation through a direct effect on the endometrium (Reilly Johnson 2010).
The correct code to assign for Lipiodol tubal flushing is 35703-01 [1248] Therapeutic hydrotubation by
following the Alphabetic Index:
Hydrotubation
- fallopian tube
- - therapeutic 35703-01 [1248]
If Lipiodol flushing is conducted with other gynaecology procedures e.g. hysteroscopy, code other
procedures as appropriate.
Improvements will be considered for a future edition of ACHI.
References:
Repromed information sheet ‘lipiodol flushing procedure’, viewed 25 February
2016, http://202.169.196.26/LinkClick.aspx?fileticket=_1nKGumnC9c%3Dtabid=1953
Reilly S Johnson N 2010, Fertility-enhancing effects of Lipiodol and the IVF-LUBE Study A multi-centre randomised trial’ OG
Magazine, vol. 12, no. 3 viewed 25 February 2016, http://www.ranzcog.edu.au/editions/doc_view/321-32-fertility-enhancingeffects-of-lipiodol-and-the-ivf-lube-study.html
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 24 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3051 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Endometrial Scratch
Q:
What is the correct code to assign for an endometrial scratch?
A:
Research suggests that by ‘scratching’ the endometrium the chemical conditions in the endometrium are
more beneficial to an implanting embryo. It is thought that a repair process begins and this allows the
release of a group of chemicals called growth factors in the endometrium, and it is these chemicals that
increase the chances of a pregnancy (Woodhead 2014).
Assign 13215-03 [1297] Other reproductive medicine procedure for endometrial scratch by following the
Alphabetic index:
Procedure
- for
- - reproductive medicine (in vitro fertilisation) NEC 13215-03 [1297]
Amendments to ACHI will be considered for a future edition.
References:
Woodhead C 2014, ‘Endometrial scratch’ Alana healthcare for Women, viewed 25 February 2016,
http://www.alanahealthcare.com.au/endometrial-scratch/
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 25 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3052 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Organ and Tissue Procurement (ACS 0030)
Q:
ACS 0030 Organ and tissue procurement and transplantation, point 2b. Donation following brain death in
hospital states:
In the procurement episode after the initial episode and following brain death, assign as principal diagnosis
the appropriate code from Z52.- Donors of organs and tissues and the relevant procedure code(s). It is not
necessary to assign diagnoses from the initial episode or cause of death as these will already have been
coded in the initial episode. Only code patients who actually proceed to organ donation.
Do these guidelines apply if the harvested organs are not used for donation?
A:
The instruction in ACS 0030 Organ procurement and transplantation cited in the query applies to those
patients who have a posthumous procurement episode of care where organs are harvested irrespective of
whether or not the organs are used for donation; even if they are returned to the donor.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 26 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3054 | Published On: 15-Jun-2016 | Status: Current | Supersedes: Q2642
SUBJECT: 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 an acute stress reaction or an
adjustment disorder classifiable to category F43 Reaction to severe stress, and adjustment disorders.
When clinical advice is unavailable or there is uncertainty regarding whether the patient has an acute stress
reaction or adjustment disorder, 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.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 27 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3063 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Lymph node neck dissection
Q:
What codes should be assigned for neck dissections described by levels rather than by the terms radical,
modified radical and so on?
A:
Cancers in the head and neck commonly metastasise to cervical lymph nodes. Neck dissection refers to a
surgical procedure in which the fibrofatty contents of the neck (including lymph nodes) are removed for
treatment of cervical lymphatic metastases.
Neck lymph nodes are divided into seven different levels. There are five levels in the lateral compartment
and two in the central compartment.
Radical neck dissection (also known as comprehensive neck dissection) involves the removal of all lymph
nodes from levels I-V on one side of the neck, with sacrifice of internal jugular vein, spinal accessory nerve
and sternocleidomastoid muscle.
Extended radical neck dissection involves radical neck dissection and removal of one or more lymph node
groups or non-lymphatic structures not accounted for in the radical neck dissection.
Radical neck dissection has largely been replaced by the modified radical neck dissection.
Modified radical neck dissection involves removal of lymph node groups I to V, while sparing one or more
of the three structures taken in the radical neck dissection (sternocleidomastoid muscle, internal jugular
vein and spinal accessory nerve).
Assign 31435-00 [806] Radical excision of lymph nodes of neck for a radical, extended radical or modified
radical neck dissection (removal of lymph node levels I-V) following the Alphabetic Index:
Dissection
- lymph node — see also Excision/lymph node/by site/radical
Excision
- lymph node
- - neck (cervical) (simple) (total)
- - - radical (complete) 31435-00 [806]
Selective neck dissection refers to a type of neck dissection in which one or more lymph node groups
normally removed in a radical neck dissection are preserved. Selective neck dissections may be divided into
the following categories: supraomohyoid neck dissection (levels I, II, III), lateral neck dissection (levels II, III,
IV), anterior compartment neck dissection (VI), and posterolateral neck dissection (levels II, III, IV, V).
Assign 31423-01 [806] Regional excision of lymph nodes of neck for a selective neck dissection following the
Alphabetic Index:
Dissection
- lymph node — see also Excision/lymph node/by site/radical
Coding Rules - Current as at 16-Jun-2016 03:50
Page 28 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Follow the cross reference to Excision/lymph node/by site only, ignoring radical in this instance as it is not
correct for a selective lymph node dissection:
Excision
- lymph node
- - neck (cervical) (simple) (total)
- - - regional (limited) 31423-01 [806]
Amendments to ACHI will be considered for a future edition.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 29 of 30
Australian Consortium for Classification Development
ACCD Classification Information Portal
Coding Rule is effective for event records with an event end date on or after 1 July 2016
Ref No: Q3055 | Published On: 15-Jun-2016 | Status: Current
SUBJECT: Conditions described as secondary to or due to
Q:
Is there a hierarchy within the subsections of ACS 0001 Principal diagnosis?
Are episodes of care where delirium is precipitated by infection/dehydration or where acute renal failure
(ARF) is precipitated by dehydration examples where ACS 0001 Principal diagnosis/Problems and underlying
conditions apply? Or does ACS 0001 Principal diagnosis/ Two or more interrelated conditions, each
potentially meeting the definition for principal diagnosis apply?
A:
The Introduction to the Australian Coding Standards states:
It is assumed that coding decisions are not made solely based on information provided on the clinical
record front sheet and/or the discharge summary (or a copy of same) but that analysis of the entire clinical
record is performed before code assignment.
If a clinical record is inadequate for complete, accurate coding, the clinical coder should seek more
information from the clinician. When a diagnosis is recorded for which there is no supporting
documentation in the body of the clinical record, it may be necessary to consult with the clinician before
assigning a code.
Applying the above and gaining an understanding of the circumstances of an admitted episode of care
should be sufficient in most instances to establish a principal diagnosis as per the definition in ACS 0001
Principal diagnosis. In addition, ACS 0001 provides specific guidelines for assignment of the principal
diagnosis in various scenarios:
•
•
•
•
•
•
•
•
Obstetrics
Aetiology and manifestation (aka the ‘dagger and asterisk’ convention)
Problems and underlying conditions
Symptoms, signs and ill-defined conditions
Acute and chronic conditions
Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis
Two or more diagnosis that equally meet the definition for principal diagnosis
Codes from the Z03.0–Z03.9 series, medical observation and evaluation for suspected diseases and
conditions
• Residual condition or nature of sequela
The points above are discrete guidelines for different circumstances and a hierarchy was not explicitly
intended, therefore a flowchart is not appropriate.
The guidelines for Two or more interrelated conditions, each potentially meeting the definition for principal
diagnosis and Two or more diagnoses that equally meet the definition for principal diagnosis are not to be
used as a default to assign ‘the first mentioned condition’ without applying the other criteria in ACS 0001.
Delirium precipitated by infection/dehydration and ARF secondary to dehydration, are examples where it is
appropriate to apply ACS 0001 Principal diagnosis/Problems and underlying conditions as each describes a
problem with an underlying condition ie there is a cause and effect (due to/secondary to) relationship.
Published 15 June 2016,
for implementation 01 July 2016.
Coding Rules - Current as at 16-Jun-2016 03:50
Page 30 of 30