'Department of Health and Human services, Victoria, Australia'

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ACS 0530 and mental health emergency presentations

Publication Date: September 2006

ICD 10 AM Edition: Fifth edition

Retired Date: 30/6/2013

Query Number: 2254

Following the implementation of the new DHS directive, to record same day transfers from ED to inpatient psychiatric care as one episode with a Care Type 5 I am querying the correct principal diagnosis assignment for these episodes. In particular, the application of ACS 0530 Drug Overdose.

You will be aware that the Standard states:
'When an admission is occasioned for treatment of a drug overdose and the patient subsequently receives treatment for an associated psychiatric condition in the same episode of care, ** the overdose should be sequenced as the principal diagnosis.
**Note that in most states the episode of care will continue to be regarded as an 'acute' care type........and therefore will be coded as one episode of care.

I foresee that application of this ACS, will adversely affect our code assignment and subsequent DRG assignment. There are numerous patients that present to ED requiring attention for their drug overdose, who once stabilised, are directly sent to an inpatient psychiatric unit for treatment of their underlying psychiatric condition(s). For various reasons they may remain on this unit for days, weeks or months. Recording the principal as their initial drug overdose seems incorrect.

As there was no mention of a Victorian Addition to this Standard at the recent 5th Edition Education Workshop, I seek clarification now.


The VICC advises to apply ACS 0530 Drug overdose if the circumstances of the admission justify the application of the standard. As stated in the June 2006 Special Edition Coding Newsletter article 'Emergency admission time and assignment of principal diagnosis' for patients who attend the emergency department and are subsequently admitted it is the decision to admit, and when this occurs, which is critical in determining principal diagnosis.

It should be noted that the footnote in ACS 0530 is the NHDD reference to 'acute' care type which includes the Victorian Mental Health Care Types. That is Victorian care types 4 (acute) and 5x (various mental health types) (for patients <65) are mapped to acute care for purposes of Commonwealth reporting.