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On a Lighter Note

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On a Lighter Note ...

    ICD Coding Newsletter

    August 1999

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 answers to selected coding queries, coding

    feature articles, and feedback on the quality of coded data (as reported to the

    Victorian Admitted Episodes Dataset).

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

    contact:

    Wendy Dickins, Sara Harrison or Shannon Watts.

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

The following proformas are provided for your use:

? Victorian ICD Coding Committee Query Form

     (Refer to page 19 of the May 1999 edition of this newsletter for guidelines on query

    submission, including alternative means of lodging a query.) ? Changes to Mailing Details.

Editors’ Note

In July 1999, the first issue of the Health Data Standards and Systems Bulletin was

    distributed to Victorian hospitals and industry bodies. Two further issues have been

    released since then.

This Bulletin is produced on an ad hoc basis, by HDSS, and provides:

    ? answers to common questions recently directed to the HDSS Help Desk

    ? directives for implementation of revisions to data collection specifications

     (VAED, VEMD, ESIS), including notification of amendments to specified data

    collection reference tables

    ? feedback on selected data quality studies undertaken, and

    ? information on upcoming events.

With the introduction of this Bulletin, the ‘Information Updates’ section of the ICD

    Coding Newsletter will cease to include material that is covered by the scope of the Bulletin. Updates relating to coding audits and selected data quality activities,

    involving coded data, will continued to be published in this newsletter.

The Bulletins are presently being loaded onto the HDSS website at:

    www.dhs.vic.gov.au/ahs/hdss

Wendy Dickins & Sara Harrison

Abbreviations

DHS Department of Human Services

    ESIS Elective Surgery Information System

    HDSS Health Data Standards and Systems

    thICD-10-AM Statistical Classification of Diseases and Related Health Problems, 10

    Revision, Australian Modification MDC Major Diagnostic Category

    PRS/2 Patient Reporting System 2

    VAED Victorian Admitted Episodes Dataset (name of the admitted patient data

    collection from 1 July 1999) VEMD Victorian Emergency Minimum Dataset

Contents

Coding Features 1

    Diabetes With Multiple Complications 1 Intraperitoneal Chemotherapy 7

    Preparation For Dialysis 11

    thVictorian Coding Committee’s 20 birthday 12

    Information Updates 14

    Data Quality 14

    Audit of 1998-1999 VIMD Data 14

    Audit of 1999-2000 VIMD Data 15 1999 Calendar of Events 16

    On a Lighter Note 17

    ICD Coding Committee 18

    ICD Coding Committee Members as at 1 August 1999 18 ICD Coding Committee Calendar of Meetings 18

Coding Features

    Diabetes With Multiple Complications

    Compiled by Andrea Groom and Linda Cornell

This Coding Feature seeks to clarify the use of code:

    E1x.7x Diabetes mellitus with multiple complications,

    following advice provided in June 1999 Coding Matters (page 14). The advice in Coding Matters is effective for separations from 1 July 1999.

Multiple complications of diabetes is coded to E1x.7x. This code is used instead of

    multiple individual E1x.xx codes (thereby overruling the dagger/asterisk

    convention). As E1x.7x does not provide detail of the specific complications, the

    ‘asterisk’ code for each complication is added. It is not necessary to assign specific

    diabetes code(s) (E1x.xx) before each complication (asterisk) code.

    E1x.7x Diabetes mellitus, with multiple complications may be assigned as the principal diagnosis or as an associated diagnosis code, depending on the reason for

    admission.

If the diabetic complication is the reason for admission, or receives specific treatment

    during the admission, these complications should be ‘coded out’, that is assign specific diabetes codes rather than .7 With multiple complications. Any other diabetic complications may be ‘bundled’ together using .7 With multiple complications.

Note that the edits regarding the use of multiple asterisk codes without their

    corresponding dagger codes have been removed from the VAED.

Example 1

    Patient admitted for treatment of a specific diabetic complication, for example

    diabetic nephropathy. The patient also has other diabetic complications of

    retinopathy and neuropathy. Following ACS 0001 to assign the principal diagnosis

    (the reason for admission), the following codes are assigned:

    E1x.2x? Diabetes mellitus, with renal complications N08.3* Glomerular disorders in diabetes mellitus

    E1x.7x Diabetes mellitus, with multiple complications May Be Reproduced ICD Coding Newsletter - August 1999 1

H36.0* Diabetic retinopathy

    G63.2* Diabetic polyneuropathy

Example 2

    If the same patient had ESRF as a complication of the diabetic nephropathy, and was

    admitted for treatment of the ESRF (not admitted for preparation for dialysis), the

    following codes would be assigned:

N18.0 End-stage renal disease

    E1x.7x Diabetes mellitus, with multiple complications N08.3* Glomerular disorders in diabetes mellitus H36.0* Diabetic retinopathy

    G63.2* Diabetic polyneuropathy

    Refer to the Coding Feature Preparation for Dialysis, page 11.

Example 3

    Patient admitted for unstable diabetes. Has diabetic complications of nephropathy,

    retinopathy and neuropathy. In this case, as no single diabetic complication is the

    th reason for admission, E1x.7x may be assigned as principal diagnosis, with a 5

    character of ‘1’ to indicate the unstable diabetes.

E1x.71 Diabetes mellitus, with multiple complications, stated as uncontrolled

    N08.3* Glomerular disorders in diabetes mellitus H36.0* Diabetic retinopathy

    G63.2* Diabetic polyneuropathy

Example 4

    Patient admitted with uncontrolled diabetes, presenting as ketoacidosis. Patient also

    has diabetic retinopathy. The following codes would be assigned:

E1x.11 Diabetes mellitus, with ketoacidosis, stated as uncontrolled

    E1x.3x? Diabetes mellitus, with ophthalmic complications H36.0* Diabetic retinopathy

2 ICD Coding Newsletter - August 1999 May be reproduced

Following ACS 0001 the reason for admission is uncontrolled diabetic ketoacidosis.

    This is therefore sequenced as principal diagnosis. As there is only one other

    diabetic complication, .7 With multiple complications is not assigned, rather the

    specific diabetes with ophthalmic complications and diabetic retinopathy codes.

May Be Reproduced ICD Coding Newsletter - August 1999 3

Example 5

    Patient admitted with diabetic hypoglycaemia (as had skipped a few meals). The

    patient also required treatment for his infected (pseudomonas) diabetic foot ulcers.

    He also has diabetic neuropathy. The following codes would be assigned:

    E1x.5x Diabetes mellitus, with peripheral circulatory complications L97 Ulcer of lower limb, NEC

    B96.5 Pseudomonas as the cause of diseases classified to other chapters E16.2 Hypoglycaemia, unspecified

    E1x.4x Diabetes mellitus, with neurological complications G63.2* Diabetic polyneuropathy

Hypoglycaemia (E16.x) is assigned as an additional code to the diabetes code

    (Coding Matters, January 1999).

Example 6

    Same patient as in example 5, but in addition has diabetic nephropathy. The

    following codes would be assigned:

    E1x.5x Diabetes mellitus, with peripheral circulatory complications L97 Ulcer of lower limb, NEC

    B96.5 Pseudomonas as the cause of diseases classified to other chapters E16.2 Hypoglycaemia, unspecified

    E1x.7x Diabetes mellitus, with multiple complications N08.3* Glomerular disorders in diabetes mellitus G63.2* Diabetic polyneuropathy

Example 7

    Patient admitted for treatment of diabetic foot so documented (has leg ulcer and

    neuropathy). The following codes would be assigned:

    E1x.7x Diabetes mellitus, with multiple complications L97 Ulcer of lower limb, NEC

    G63.2* Diabetic polyneuropathy

    This illustrates another instance where .7 With multiple complications can be the principal diagnosis code. ACS 0401 Diabetes Mellitus, Diabetic foot (page 72) gives

    further detail regarding the coding of Diabetic Foot.

4 ICD Coding Newsletter - August 1999 May be reproduced

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