EmailACS 1541 Elective and emergency caesarean
Publication Date: May 2003
ICD 10 AM Edition: Third edition
Retired Date: 30/6/2010
Query Number: 1894
We are querying the intent of ACS 1541 Elective and Emergency Caesarean, particularly in relation to the mismatch of an anaesthetist’s definition of either elective or emergency via the use of ASA scores. If the anaesthetist documents ‘E’ for emergency, coders have no choice but to code emergency (anaesthetic) and are concerned when, on occasion, ‘elective and emergency’ do not match. For example, a patient with a history of two LUSCSs is booked to have an elective LUSCS on 19 February on the basis of current breech presentation and previous history. On 13 February she was admitted contracting with bulging membranes and couldn’t get a satisfactory CTG reading so the decision was made for a LUSCS. ‘Emergency LUSCS’ documented by anaesthetist ASA = 1E and ‘Emergency LUSCS’ documented by obstetrician. However, ACS 1541 Elective and Emergency Caesarean precludes the use of ‘emergency’ LUSCS and therefore we have to code
16520-02 [1340] Elective lower segment caesarean section
From a clinical risk management point of view, ACS 1541 makes it impossible to capture elective caesareans that become emergency. This high-risk group is therefore unable to be easily identified through our morbidity collection. We want to include emergency caesareans in our medical record screening program but retrieval by the emergency caesarean code doesn’t capture all the cases we feel need to be looked at. The difference in terminology becomes a problem in comparing statistics, as the Perinatal Data Collection Unit (PDCU) classifies booked caesareans that become emergency as ‘emergency’ whereas ours stay ‘elective’. Perhaps the time has come to identify these two groups with a fifth digit for ‘emergency caesarean’ and ‘emergency caesarean booked elective’ to align with PDCU etc.
16520-02 [1340] Elective lower segment caesarean section
From a clinical risk management point of view, ACS 1541 makes it impossible to capture elective caesareans that become emergency. This high-risk group is therefore unable to be easily identified through our morbidity collection. We want to include emergency caesareans in our medical record screening program but retrieval by the emergency caesarean code doesn’t capture all the cases we feel need to be looked at. The difference in terminology becomes a problem in comparing statistics, as the Perinatal Data Collection Unit (PDCU) classifies booked caesareans that become emergency as ‘emergency’ whereas ours stay ‘elective’. Perhaps the time has come to identify these two groups with a fifth digit for ‘emergency caesarean’ and ‘emergency caesarean booked elective’ to align with PDCU etc.
Response
The Committee believes that the definitions of emergency and elective Caesarean as defined by the PDCU are consistent with the definitions outlined in ACS 1541 Elective and Emergency Caesarean. It would seem that the inquirer has misinterpreted the PDCU definition of ‘elective caesarean - labour’, and should refer to ‘Births in Victoria 1999-2000’ published by the PDCU, Victoria 2001, for the current definitions.
If an anesthetist is assessing a patient in an emergency situation, the ASA modifier ‘E’ will indicate this. An anaesthetist is not concerned with whether the patient has a Caesarean planned for a future date. Therefore, it can be entirely appropriate to have ‘inconsistency’ in terms of the ASA ‘emergency’ indicator relating to an ‘elective’ Caesarean procedure code.
The collection of data for elective caesareans that become emergency caesareans is made difficult by this coding practice; however, both the ACS and the PDCU definitions support this practice.
If an anesthetist is assessing a patient in an emergency situation, the ASA modifier ‘E’ will indicate this. An anaesthetist is not concerned with whether the patient has a Caesarean planned for a future date. Therefore, it can be entirely appropriate to have ‘inconsistency’ in terms of the ASA ‘emergency’ indicator relating to an ‘elective’ Caesarean procedure code.
The collection of data for elective caesareans that become emergency caesareans is made difficult by this coding practice; however, both the ACS and the PDCU definitions support this practice.
