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ACS 1530 and ACS 1515

Publication Date: March 2007

ICD 10 AM Edition: Fifth edition

Retired Date: 30/6/2013

Query Number: 2277

ACS 1530 Premature Delivery and ACS 1515 Antepartum Condition with Delivery appear to provide conflicting advice with regards to the principal diagnosis for obstetric cases.

For example:
A 30 year old primigravida was admitted at 34 weeks gestation on 1.9.06 with severe pre-eclampsia. On 10.9.06 she underwent an emergency caesarean delivery due to fetal distress.

ACS 1530 states if the reason for early delivery is documented in the clinical record, code this as the principal diagnosis, followed by O60.1.

ACS 1515 states if an episode of care includes delivery of a baby but the patient was admitted for an antepartum condition which required treatment for more than seven days before the birth, sequence the antepartum condition as the principal diagnosis.

According to ACS 1530 fetal distress should be the principal diagnosis.

According to ACS 1515 severe pre-eclampsia should be the principal diagnosis.

Please advise which ACS takes preference in this example.

Search Details: ACS 1530 and ACS 1515


Draft response to enquirer:

The VICC advises to follow the advice published in Coding Matters Volume 13, Number 2 Frequently asked questions - part 1:
Q: Is there a rule regarding principal diagnosis selection for obstetric cases?
A: Chapter 15 of the ACS provides a number of standards which deal with principal diagnosis selection, in particular ACS 1515 Antepartum condition with delivery and ACS 1530 Premature delivery. If none of these standards apply, ACS 0001 Principal diagnosis should be followed. In obstetric cases, the reason for admission is for the safe delivery of the baby and, therefore, in most instances the principal diagnosis will be based on the sequence of events surrounding the delivery. However, there may be some exceptions to this, therefore, coders should follow ACS 0001 Principal diagnosis for code assignment. This issue is currently under review.

The VICC will forward this query to NCCH as examples when reviewing ACS 0001 Principal diagnosis for obstetrics.