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Human Services Normal v21 ...

    ICD Coding Newsletter

    May 2000

Hospital Distribution List

? Health Information Manager/s (HIMS)

    ? Clinical Coders

    ? Information Technology (IT)

    ? Interested Others

    ……………………

    ……………………

    ……………………

The ICD Coding Newsletter supports the clinical coding function performed

    in Victoria by Health Information Managers and Clinical Coders, by

    providing relevant information for these professionals and their associates.

    The newsletter, prepared by the Victorian ICD Coding Committee in conjunction with the Department of Human Services, seeks to:

    ? ensure the standardisation of coding practice across the state, ? provide a forum for resolution of coding queries, ? address topical coding education issues, and

    ? inform on national and state coding issues from the Victorian perspective.

    The scope of the newsletter includes coding feature articles, selected coding queries and responses, and various information updates including feedback on the quality and uses of coded data (as reported to the Victorian Admitted Episodes Dataset).

Should you have any queries or comments regarding the ICD Coding Newsletter,

    contact:

Shannon Watts, Sara Harrison or Wendy Dickins.

HDSS Help Desk:

    Telephone 9616 8141

    Fax 9616 7629

    Email PRS2.Help-Desk@dhs.vic.gov.au

    Website www.dhs.vic.gov.au/ahs/hdss

    Notification of change of address or requests regarding the mailing list may be directed to any of the above contacts.

The following proforma is provided for your use:

? Victorian ICD Coding Committee Query Form.

     An electronic coding query form can also be found at:

www.dhs.vic.gov.au/ahs/hdss/icdquery.htm

    ii ICD Coding Newsletter - May 2000 May be reproduced

Contents

    Coding Features............................................................................................. 1 Cochlear Implant Procedure ............................................................................... 1

List of Selected ICD-10-AM Coding Queries .............................................. 6

    Coding Queries and Responses .......................................................................... 8

Coding Corkboard ....................................................................................... 33

    Seeking New Coding Committee Member/s ................................................. 33

Information Updates ................................................................................... 36

    Data Quality ....................................................................................................... 36

    Audits of VAED Data .................................................................................... 36

    Clinical Data Use ............................................................................................... 38

    Coding and Data at the Australian Health Service Alliance (AHSA) ...... 38

2000 Calendar of Events ............................................................................. 36

ICD Coding Committee .............................................................................. 41

    Member Profile - Glenda Cunningham ........................................................... 41 Members as at 1 May 2000 ................................................................................ 45 Calendar of Meetings ........................................................................................ 45

On a Lighter Note ........................................................................................ 46

Alphabetic Index to Victorian ICD-10-AM Coding Advice: July 1999 -

    May 2000 ...................................................................................................... 47

Abbreviations .............................................................................................. 55

May be reproduced ICD Coding Newsletter - May 2000 iii

iv ICD Coding Newsletter - May 2000 May be reproduced

Coding Features

    Cochlear Implant Procedure

Compiled by Kelly Lyngcoln and Fiona Moulder, The Royal Victorian Eye

    and Ear Hospital

The cochlear implant (bionic ear) is designed to produce meaningful sounds to

    profoundly deaf individuals by electrically stimulating nerves inside the inner ear.

History of the Implant

    This revolutionary surgery was first performed in 1978 when a multi-channel unit

    was implanted into an adult after many years of research by Professor Graeme Clark

    and the staff at the University of Melbourne Department of Otolaryngology, at The

    Royal Victorian Eye and Ear Hospital. By the end of 1984, The Royal Victorian Eye

    and Ear Hospital’s Cochlear Implant Clinic had been established and 22 profoundly

    deaf adults had received the Nucleus multi-channel hearing device. The results of

    the first group of patients were encouraging and the first implant procedure on a

    child was performed in 1985. There has been much advancement in the device used,

    and there are now a number of devices to choose from, that are being marketed all

    over the world.

Selection of surgical candidates

Before an implant can be considered, a number of tests must be carried out to assess

    a person’s suitability and potential benefit from the surgery. A team of otologists,

    audiologists, speech pathologists, neurologists, social workers and educationalists

    are involved in this process. The selection criteria are:

? The person must be at least 12 months old.

    ? The person must have little or no hearing in both ears. Only those patients with

    profound, severe hearing loss will be considered for the surgery as the implant

    would be of little benefit to those patients with higher levels of hearing. Both

    standard audiometry and Steady State Evoked Potential (SSEP) techniques may

    be used to test the current hearing ability.

    May be reproduced ICD Coding Newsletter - May 2000 1

    ? The use of hearing aids must be of little benefit. If the candidate can gain

    significant results from a properly fitted hearing aid, then the implant procedure

    may not be necessary. Evaluating a person’s hearing using hearing aids also

    helps to determine the ear to be operated on, that is, the one with the least

    hearing. This criteria is becoming less stringent, as the results of the implant

    improve hearing to a level which is often better than a person with well fitted

    hearing aids.

    ? Verbal or pre-verbal communication skills will have been developed prior to

    surgery. It is important to assess whether auditory input has been able to

    contribute to the development of their communication skills in the past.

    ? The person must be medically able to undergo a general anaesthetic.

    ? Both candidates and their families must be prepared to practice after the implant

    to establish their communication and listening skills. There should also be

    realistic expectations of what the implant will achieve for the candidate before

    the surgery, so that there will not be disappointment when the outcome is

    different to what was anticipated.

    ? The ears themselves must be healthy and free of infection before an implant can

    be considered. An Ear, Nose and Throat Surgeon will examine the candidate for

    external or middle ear disease such as otitis media. It is possible that such

    pre-existing pathology will make the patient unsuitable for an implant.

    ? The cochlea must be properly formed so that the electrode section can be

    implanted within it. Abnormal bone growth within the cochlea may make the

    ear unsuitable for the procedure, so a CT scan of the inner ear is routinely

    performed to exclude this before surgery.

    ? Coding tip! Children are admitted for a CT scan as they require a

    general anaesthetic. The most common scan is a computerised

    tomography of the middle ear, temporal bone and brain, bilateral:

    56016-06 [1955].

     Also assign a code for the general anaesthetic, refer to ACS 0031, page 35.

    (This standard applies pre and post 1 July 2000).

    ? The auditory nerve must be intact as this nerve carries electrical pulses from the

    ear to the brain. A Promontory Stimulation Test is performed (on an outpatient

    basis), to establish if the auditory nerve is still working. This test involves

    passing electrical signals to the hearing nerve via an electrode placed in the ear. 2 ICD Coding Newsletter - May 2000 May be reproduced

Function of the cochlear implant

The hearing process using a cochlear implant can be summarized as follows:

a. Sounds and speech are detected by the microphone.

    b. The information from the microphone is sent to the speech processor. c. The speech processor analyses the information and converts it into an electrical

    code.

    d. The coded signal travels via a cable to the transmitting coil in the headset. Radio

    waves from the transmitter coil carry the coded signal through the skin to the

    implant inside.

    e. The implant package decodes the signal. The signal contains information that

    determines how much electrical current will be sent to the different electrodes. f. The appropriate amount of electrical current passes down the appropriate lead

    wires to the chosen electrodes.

    g. The position of the stimulating electrodes within the cochlea will determine the

    frequency or pitch of the sounds. The amount of electrical current will

    determine the loudness of the sounds.

    h. Once the nerve endings in the cochlea are stimulated, the message is sent up to

    the brain along the acoustic nerve. The brain can then try to interpret the

    stimulation as meaningful sound.

May be reproduced ICD Coding Newsletter - May 2000 3

The speech processor does not just make sounds louder as a hearing aid does, it

    selects parts of the speech signal and produces an electrical pattern which creates

    sound as close to the original speech sound as possible. It is not possible to make

    the sound completely natural as there are only 22 electrodes which replace the

    function of tens of thousands of hair cells in a normally hearing ear.

The surgery

The receiver stimulator pack is implanted into the temporal bone in the skull via an

    incision behind the ear and is positioned flat against the bone. Access into the

    delicate cochlea is gained via a hole which is drilled into the temporal bone. A small

    hole is created in the cochlea itself and the electrodes are gently guided into the

    cochlea. The wound is then closed, with the surgery usually lasting for two to three

    hours. The patient will then stay in hospital for three to four days.

    ? Coding tip! The code for insertion of a cochlear implant is:

     41617-00 [329] Implantation of cochlear prosthetic device.

    From 1 July 2000, assign also, a code for the anaesthesia, refer to

    ACS 0031, page 35.

Possible complications of the surgery

    ? Infection at the site of the implant sometimes requiring removal of the device.

    ? Coding tip! The code for a removal of a cochlear implant is:

     41617-01 [329] Removal of cochlear prosthetic device.

    ? Leakage of fluid from the cochlea itself.

    ? Injury to the facial nerve.

    ? Disturbance of taste.

    ? Giddiness.

    ? Increased tinnitus.

    ? Electronic failure of the implant requiring removal and replacement of the

    device.

    ? Unsuccessful electrical stimulation due to an insufficient number of existing

    hearing nerve fibres.

    ? Some electrodes may inadvertently stimulate non hearing nerves causing

    discomfort, so these are unable to be used which will lessen the efficacy of the

    implant.

    ? If an implanted patient needs to undergo Magnetic Resonance Imaging for any

    reason, the magnet in the cochlear implant would need to be surgically removed.

    4 ICD Coding Newsletter - May 2000 May be reproduced

Post-operative rehabilitation

    After the operation the patient will attend the Cochlear Implant Clinic at the Royal Victorian Eye and Ear Hospital on a weekly basis for two to three months. During these visits, training in the use of the device is provided and ‘mapping’ of the device is undertaken. Once these processes have been mastered, the frequency of visits are reduced to every six or twelve months or whenever the need arises. For children the process is usually maintained to allow for continuing speech and language therapy - sometimes for a number of years. All patients require an annual or six monthly check-up which may also include re-mapping of their speech processor.

Mapping of the device

    Before any sounds are heard with the implant, a clinician must fit the implanted person with the speech processor and headset. As each person’s auditory pathway functions differently, the speech processor must be mapped to each person individually. This programming involves setting levels which will produce either very soft or comfortably loud sounds for patients. This process is undertaken via the use of a computer which sends signals to the speech processor to be interpreted by the implanted patient. The speech processor must be mapped frequently for the first few months, to allow the body to adjust to the implant.

Learning to use the implant

    Much practice is involved in learning what are sometimes new sounds for implanted patients. This process involves listening to words, sentences and conversations and for some, practicing lip reading skills. For children who are pre-linguistically deaf, that is they have not developed any language or speech skills before deafness, the implant may be required to be used in conjunction with lip reading, to maximise its effect.

References

www.medoto.unimelb.edu.au, Cochlear Implant Clinic

May be reproduced ICD Coding Newsletter - May 2000 5

List of Selected ICD-10-AM Coding

    Queries

#1465 Sternal wires ........................................................................................................... 8

    #1470 Transjugular liver biopsy ....................................................................................... 9

    #1471 Vulval, vaginal and perianal warts ...................................................................... 9

    #1475 Lacerated bowel and bladder during LUSCS ................................................... 10

    #1476 Re-inflation of breast implant ............................................................................. 11

    #1482 Incision and drainage of submandibular abscess.............................................. 11

    #1486 Photodynamic therapy (PDT) ............................................................................. 13

    #1490 Senile gait apraxia ................................................................................................ 14

    rdth#1517 Amputation distal 3 and 4 fingers with reattachment ................................. 15

    #1520 Amputation and open fractures ......................................................................... 16

    #1527 Pre-admission tests ............................................................................................. 17

    #1529 ACS 0012 Suspected conditions ......................................................................... 19

    #1532 Decreased conscious state ................................................................................... 20

    #1535 Bath drain removed from fingers ....................................................................... 20

#1538 Infective exacerbation of COPD with emphysema .......................................... 21

    #1539 Diathermy of penile wart ................................................................................... 22

    #1540 Revision of a laparoscopic Nissen Fundoplication .......................................... 23

    #1541 Coffin-Lowry syndrome ..................................................................................... 24

    #1542 Schizoaffective disorder, hypomanic................................................................. 24

    #1543 Lip - Labial melanotic macule ............................................................................ 26

    #1544 Chronic schizophrenia ........................................................................................ 27

    #1545 Metastatic spread ................................................................................................ 28 6ICD Coding Newsletter - May 2000 May be reproduced

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