Ref Code: Q2695 | Published On: 15-Dec-2012 | Status: Current
ACS 0604 Stroke - Coding of sequelae of CVA with deficits not meeting ACS 0002 Additional diagnoses
Q:
In Example 2 in ACS 0604 Stroke there is an instruction to code the hemiparesis even though it wasn't treated. How would the hemiparesis meet ACS 0002 if no treatment is given?
A:
NCCC confirms previous advice published by NCCH in Coding Matters (2002) which states:
"Patients who have had a previous stroke and are left with residual deficits should have these conditions coded when they meet the criteria for an additional diagnosis (ACS 0002 Additional diagnoses)."
Example 2 of ACS 0604 Stroke, indicates that an additional code for hemiparesis should be assigned. The example is not explicit about how it meets ACS 0002 Additional diagnoses, however, clinical coders should be guided by the advice cited above and make a determination on whether a deficit meets ACS 0002 by review of the entire clinical record.
Example 2 of ACS 0604 will be clarified for a future edition of the Australian Coding Standards.
Reference:
National Centre for Classification in Health (2002), Coding Matters: 10-AM Commandments, Vol. 9, No. 2.

Ref Code: Q2731 | Published On: 15-Dec-2012 | Status: Current
Acquired redundant colon
Q:
What is the correct code assignment for acquired redundant colon?
A:
A redundant colon is an anatomical variant and consists of extra loops making it longer than normal. Clinical advice confirms that redundant colon can be congenital or acquired. An acquired redundant colon typically occurs in adults over the age of 60 with risk factors such as an enlarged colon and intestinal pseudo obstructions, a bowel blockage caused by nerve or muscle problems affecting the flow of food, liquid and air through the intestines with contributing factors such as constipation, chronic laxative abuse, long standing immobility, dietary deficiencies, toxicity in the colon and the presence of pathogenic organisms.
The appropriate code to assign for acquired redundant colon is K63.8 Other specified diseases of intestine following the index pathway:
Deformity
- colon
- - acquired K63.8
Clarification should be sought from the clinician if the documentation does not specify whether it is an acquired or congenital redundant colon.
When clarification from the clinician is not possible, assign Q43.89 Other specified congenital malformations of intestine by following the index pathway:
Redundant
- colon (congenital) Q43.8
The NCCC will consider indexing improvements for redundant colon in a future edition of ICD-10-AM.

Ref No: Q2782 | Published On: 15-Dec-2012 | Status: Current
CIN III as principal diagnosis and indication for LLETZ procedure
Q:
What should be assigned as principal diagnosis when CIN III is documented on a Pap smear as the indication for LLETZ procedure, however histopathology after the procedure reveals CIN II or CIN I?
A:
A Large Loop Excision of the Transformation Zone (LLETZ) procedure of the cervix is performed after an abnormal Pap smear to treat pre-cancerous cells (CIN II/CIN III or high grade squamous intraepithelial lesions (HSIL/HGSIL)). This procedure uses an electric current passed through a fine wire loop electrode to shave abnormal tissue from the transformation zone of the cervix. This tissue is then sent for pathological analysis.
For the scenario cited, clinical advice confirms that a code for the higher grade lesion (CIN III) should be assigned as the principal diagnosis. This is also supported by the advice in ACS 0236 Neoplasm coding and sequencing which states:
"The primary malignancy can be coded if the episode of care is for:
• treatment aimed at stopping the cancer progression..."
Bibliography:
Australian Government Department of Health and Ageing(2006), National Cervical Screening Program resources - "An abnormal Pap smear result: What this means for you?",accessed: September 2012, available: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/EFAA19DECAA2111ACA2574EB007F73AF/$File/pap-smear.pdf.
(Coding QA, December 2012)

Ref Code: Q2784 | Published On: 15-Dec-2012 | Status: Current
Choroidal neovascularisation
Q:
What is the correct diagnosis code for choroidal neovascularisation?
A:
Choroidal neovascularisation is a neovascular response to breaks in Bruch's membrane, a deep layer in the retina, resulting in a neovascular membrane forming under the retina (Dr Ralph Higgins, personal communication, September 2012). The new vessels when formed in the macula area of the retina leak fluid and blood leading to scar tissue formation and severe visual loss.
It may occur as an idiopathic entity or in association with wet age related macular degeneration (wet AMD), extreme (high) myopia, ocular trauma, ocular histoplasmosis and inflammatory disease of choroid and retina.
Clinical advice confirms that it is a choroidal disease that secondarily involves the retina once the neovascular membrane has broken through to the retinal layers. The correct diagnosis code for choroidal neovascularisation is H31.8 Other specified disorders of choroid following the index pathway:
Disease, diseased
- choroid
- - specified NEC H31.8
NCCC will consider indexing improvements for choroidal neovascularisation in a future edition of ICD-10-AM.

Ref No: Q2736 | Published On: 15-Dec-2012 | Status: Updated | Updated On: 30-Jun-2013
Conventions used in the Tabular List of Diseases
Could clarification be provided on how to apply the principle of translating medical statements into code, where there are inclusion terms and excludes notes as in the following scenarios:
Q:
Excludes notes - type 1 and type 2
There is an excludes note at K56.1 Intussusception that directs the coder to K38.8 Other specified diseases of appendix for the condition 'intussusception of appendix', where it is listed as an inclusion term. Can both these codes be assigned in order to translate the medical statement? (refer Coding Matters, March 2008 (Volume 14, Number 4))
A:
The instruction in the Conventions used in the Tabular List of Diseases, regarding translating medical statements into code, applies primarily to excludes notes and the principles of multiple condition versus single condition coding. The concept of multiple coding outlined in ACS 0001 Principal Diagnosis and 0002 Additional Diagnoses, highlights common areas where multiple codes are required to reflect multiple concepts such as aetiology and manifestation, specifying infectious and toxic agents, neoplasm morphology etc.
The previous advice regarding 'Intussusception of appendix' in CodingMatters, March 2008 (Volume 14, Number 4) Type 2 Excludes notes is correct. It highlights that the excludes note at K56.1 Intussusception is a 'type 2' excludes note and should be followed ie. you might think 'it' goes here but it doesn't. K38.8 Other specified diseases of appendix is the only code required to classify 'intussusception of appendix' and its assignment is supported in the Alphabetic Index. The concept has been classified to K38.8 and there are not multiple concepts to translate.
If the Alphabetic Index is followed correctly, K38.8 is assigned and a coder would not even be aware there is an excludes note at K56.1.
Q:
Postprocedural complications
Code titles for T82.8, T83.8, T84.8 and T85.8 (complications of devices, implants and grafts) do not include haemorrhage and/or haematoma; however 'Haemorrhage due to cardiac and vascular prosthetic devices, implants and grafts' is listed as an inclusion term. Should T81.0 Haemorrhage and haematoma complicating a procedure, not elsewhere classified be assigned to translate the medical statement where the wound haematoma meets ACS 0002 and is a complication of a procedure such as insertion of a pacemaker generator? (refer Coding Matters, September 2009 (Volume 16, Number 2))
A:
With respect to the code assignment for postprocedural complications, ICD-10-AM classifies these 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.
To classify a complication due to or associated with prosthetic implants, devices and grafts assign one of the following codes as appropriate:
T82.8 Other specified complications of cardiac and vascular prosthetic devices, implants and grafts
T83.8 Other complications of genitourinary prosthetic devices, implants and grafts
T84.8 Other complications of internal orthopaedic prosthetic devices, implants and grafts
T85.81 Other complications due to nervous system device, implant and graft
T85.88 Other complications of internal prosthetic device, implant and graft, NEC
Assignment of T81.0 Haemorrhage and haematoma complicating a procedure, not elsewhere classified is not correct for a haemorrhage/haematoma complicating the insertion of a prosthetic device as this is a 'not elsewhere classified' code in category T81 Complications of procedures, not elsewhere classified.
This is supported by the:
• Alphabetic Index,
• note at T81 which excludes "specified complications classified elsewhere, such as: complications of prosthetic devices, implants and grafts", and
• advice in ACS 1904 Procedural complications, which 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 graft'."
ACS 1904 also specifies that:
"An additional code from Chapters 1 to 19 should be assigned where it provides further specificity."
The assignment of an additional code, as per this guideline, allows further specification of the complication as appropriate.
This advice supersedes the previous advice published in Coding Matters, September 2009 (Volume 16, Number 2), FAQs Q1, which was retired on 31 December 2012.
(Coding QA, December 2012)
This advice has a minor modification to correspond with an update in a subsequent edition of ICD-10-AM/ACHI/ACS.
Ref No: Q2714 | Published On: 15-Dec-2012 | Status: Current
Diabetes mellitus and eradicated cataract
Q:
Is E1-.39 *Diabetes mellitus with other specified ophthalmic complications the correct code to use for diabetes mellitus with history of cataract eradicated by previous surgery? If so, does the assignment of E1-.39 in this scenario count towards the criteria for assignment of E1-.71 *Diabetes mellitus with multiple microvascular and other specified nonvascular complications?
A:
Current clinical advice confirms that surgery to remove a cataract in a patient with DM does eradicate the ophthalmic complication, therefore E1-.39 *Diabetes mellitus with other specified ophthalmic complications should not be assigned. And consequently, eradicated cataract does not contribute to the allocation of E1-.71 *Diabetes mellitus with multiple microvascular and other specified nonvascular complications.
Please note: The final DM education material which was placed on the NCCC website (posted June 2012) includes this advice, however the material distributed at the Diabetes Workshops did not (as these were conducted before we were made aware of the updated clinical advice).
Please refer to ACS 0401 Diabetes mellitus and intermediate hyperglycaemia, 7. Eradicated conditions and DM (1 July 2012) for revised instructions and examples which reflect current clinical advice.
(Coding QA, December 2012)

Ref No: Q2735 | Published On: 15-Dec-2012 | Status: Current
Diagnosis code for sterilisation when performed in conjunction with other procedures
Q:
When an elective sterilisation is performed at the same time as another procedure, eg. a caesarean section, is it necessary to assign Z30.2 Sterilisation as an additional diagnosis?
A:
It is correct to assign Z30.2 Sterilisation as an additional diagnosis code when a sterilisation procedure is performed electively in the same operative episode as another procedure, such as a caesarean section. Assignment of the procedure code alone does not indicate that the procedure has been performed electively, rather than for a medical reason.
This is consistent with international coding practice.
(Coding QA, December 2012)

Ref No: Q2789 | Published On: 15-Dec-2012 | Status: Current
Endoscopic clipping of a bleeding duodenal arteriovenous malformation
Q:
What is the correct code to assign for endoscopic clipping of a bleeding duodenal arteriovenous malformation (AVM)?
A:
Clinical advice confirms that the procedure for endoscopic clipping of a bleeding duodenal arteriovenous malformation (AVM) is similar to endoscopic clipping of bleeding duodenal ulcer in technique, complexity and resource use.
Therefore, the correct code to assign for endoscopic clipping of a bleeding duodenal AVM is 90296-00 [887] Endoscopic control of peptic ulcer or bleeding.
NCCC will consider improvements to ACHI to reflect this advice for a future edition.
(Coding QA, December 2012)

Ref No: Q2722 | Published On: 15-Dec-2012 | Status: Current
Failed trial of labour and failure to progress
Q:
What is the difference between failed trial of labour and failure to progress?
A:
Current clinical advice regarding these terms provided the following information:
Failure to progress (in labour) - is a description rather than a diagnostic term, therefore, where possible, coders should assign a code for the underlying condition resulting in the 'failure to progress'. The patient must be in an active phase of labour (ie. cervix is dilated to >= 4cms and regular contractions are occurring with or without ruptured membranes), before failure to progress can be established. Underlying causes may include cephalopelvic disproportion, fetal malpresentation, incoordinate uterine action (primary uterine inertia or secondary uterine inertia), cervical dystocia or maternal exhaustion. The clinician will consider why labour is not progressing, make a diagnosis and then use interventions such as amniotomy and/or augmenting labour with oxytocins.
In the absence of documentation of an underlying cause for 'failure to progress' clinical advice indicates that the correct code to assign is O62.9 Abnormalities of forces of labour, unspecified following the index pathway:
Failure, failed
-to
-- progress (in labour) NEC O62.9
Failed trial of labour - is also adescription rather than a diagnostic term, therefore coders should assign, where possible, a code for the underlying condition resulting in a caesarean birth after trial of labour (TOL). A trial of labour can be undertaken because of potential problems due to small maternal size, large fetal size or for patients who have had a previous caesarean section to see if a vaginal delivery can be achieved. Other terminology used to describe this type of trial of labour include 'trial of scar', VBAC (Vaginal Birth after Caesarean) attempt or 'trial of vaginal birth after Caesarean' (TOVBAC). Trials of labour fail because women fail to progress, usually because of fetal malpresentation, cephalopelvic disproportion or fetal distress. Conditions that may result from a failed trial of labour include uterine rupture or fetal distress. See also ACS 1506 Malpresentation, disproportion and abnormality of maternal pelvic organs.