EmailACS 0303 Abnormal coagulation profile
Publication Date: March 2007
ICD 10 AM Edition: Fifth edition
Retired Date: 30/6/2013
Query Number: 2268
We have read ACS 0303 Abnormal coagulation profile and understand the scenarios you have made available. We have read and re-read the standard and still require your help. We have read FAQ's in 2002 from NCCH which didn't shed much light either.
Can you only code D68.x Other coagulation defects when it is the sole reason for admission or can you code this in scenarios 2 & 3? Can you code this when found incidentally during admission?
Patient admitted three times with AF.
1. First admission, patient admitted with AF - is on warfarin. INR's are monitored during admission and warfarin dose altered. Unstable/high/low INR's have not been documented. Coded as:
I48 Atrial fibrillation and flutter
Z92.1 Personal history of long term (current) use of anticoagulants
2. Second admission, patient admitted with AF - is on warfarin. Documented on discharge summary as 'Subtherapeutic INR levels' as an additional diagnosis. Patient's INR's monitored during admission and warfarin dose altered. Coded as:
I48 Atrial fibrillation and flutter
D68.8 Other specified coagulation defects
or
I48 Atrial fibrillation and flutter
Z92.1 Personal history of long term (current) use of anticoagulants
Unsure which option.
3. Third admission, patient admitted with AF - is on warfarin. INRs monitored during admission. High INR levels found day after admission. Documented as 'high INR levels- Vitamin K given' on discharge summary.
Coded as: I48, D68.3. Is this correct?
Can you only code D68.x Other coagulation defects when it is the sole reason for admission or can you code this in scenarios 2 & 3? Can you code this when found incidentally during admission?
Patient admitted three times with AF.
1. First admission, patient admitted with AF - is on warfarin. INR's are monitored during admission and warfarin dose altered. Unstable/high/low INR's have not been documented. Coded as:
I48 Atrial fibrillation and flutter
Z92.1 Personal history of long term (current) use of anticoagulants
2. Second admission, patient admitted with AF - is on warfarin. Documented on discharge summary as 'Subtherapeutic INR levels' as an additional diagnosis. Patient's INR's monitored during admission and warfarin dose altered. Coded as:
I48 Atrial fibrillation and flutter
D68.8 Other specified coagulation defects
or
I48 Atrial fibrillation and flutter
Z92.1 Personal history of long term (current) use of anticoagulants
Unsure which option.
3. Third admission, patient admitted with AF - is on warfarin. INRs monitored during admission. High INR levels found day after admission. Documented as 'high INR levels- Vitamin K given' on discharge summary.
Coded as: I48, D68.3. Is this correct?
Response
The NCCH has acknowledged that there are deficiencies in ACS 0303 Abnormal coagulation profile and the standard is currently being reviewed for Sixth Edition to include advice when abnormal coagulation profile occurs during an admission.
The VICC considers that information contained in ACS 0303 can be applied to episodes where abnormal coagulation profile is not the reason for admission.
With regards to your scenarios:
1. The VICC agrees with the enquirer's code assignment of Z92.1 Personal history of long term (current) use of anticoagulants as the patient does not have an abnormal coagulation profile and the warfarin levels are monitored and altered therefore meeting additional diagnosis criteria.
2. 'Subtherapeutic INR levels' means that the patient is underwarfarinised, therefore as per ACS 0303 the correct code to assign is D68.8 Other specified coagulation defects.
3. The VICC agrees with the enquirer's code assignment of D68.3 Haemorrhagic disorder due to circulating anticoagulants as the patient is overwarfarinised as per the documentation of high INR levels.
Please refer to #2721 Underwarfarinisation for Seventh Edition advice regarding scenario 2.
The VICC considers that information contained in ACS 0303 can be applied to episodes where abnormal coagulation profile is not the reason for admission.
With regards to your scenarios:
1. The VICC agrees with the enquirer's code assignment of Z92.1 Personal history of long term (current) use of anticoagulants as the patient does not have an abnormal coagulation profile and the warfarin levels are monitored and altered therefore meeting additional diagnosis criteria.
2. 'Subtherapeutic INR levels' means that the patient is underwarfarinised, therefore as per ACS 0303 the correct code to assign is D68.8 Other specified coagulation defects.
3. The VICC agrees with the enquirer's code assignment of D68.3 Haemorrhagic disorder due to circulating anticoagulants as the patient is overwarfarinised as per the documentation of high INR levels.
Please refer to #2721 Underwarfarinisation for Seventh Edition advice regarding scenario 2.
