EmailACS 1006 Respiratory support
Publication Date: June 2007
ICD 10 AM Edition: Fifth edition
Retired Date: 30/6/2013
Query Number: 2297
Patient admitted to ED at 10.00am. Patient intubated in ED at 11.00am and immediately commenced SIMV. At 1.00pm decision is made to send the patient to the Cath Lab/Radiology/Theatre where the patient undergoes a procedure/surgery (still ventilated). Procedure completed at 4.00pm and patient is transferred to ICU where they continue SIMV until 6.00am the next morning, at which point the patient is extubated.
Total MV hours is 19. Should 13882-00 [569] Management of continuous ventilatory support <= 24 hours be assigned (as well as an initiation code)? ACS 1006 point 5 states:
'Assign a code for continuous ventilatory support for periods <= 24 hours ONLY when the ventilation is not performed during a procedure. For example, ventilation for <= 24 hours in intensive care after head injury or burns should be coded.
The ventilatory support that is provided to a patient during surgery is associated with anaesthesia and is considered an integral part of the surgical procedure and therefore ventilation of <= 24 hours should not be coded in these cases. However, CVS initiated during surgery and continuing for greater than 24 hours should be coded with duration beginning at the time of intraoperative intubation.'
It seems that coders interpret this standard in two different ways:
1) That because the initial ventilation was not for the initiation of a procedure/surgery that point 5 does not apply and that 13882-00 could be assigned in the above example.
2) That even though the ventilation was initiated for a reason other than initiation of a procedure/surgery (for example decreasing conscious state) that 13882-00 cannot be assigned because the patient was ventilated during the procedure/surgery and total MV hrs was less than 24..
The ICD Coding Newsletter in August 2000 states 'For coding periods of CVS of less than 24 hours, there is a difference between episodes separated:
- before 1 July 2000, when periods of CVS of less than 24 hours were not coded;
- on or after 1 July 2000, when periods of CVS of less than 24 hours are coded except when CVS is initiated for a surgical procedure'.
The confusion arises around the term 'during' in ACS 1006 ie 'Assign a code for continuous ventilatory support for periods <= 24 hours ONLY when the ventilation is not performed during a procedure'. Should 'during' be interpreted to mean 'for initiation of' a procedure?
Q1 Can you advise whether 13882-00 [569] Management of continuous ventilatory support <= 24 hours should be assigned (as well as an initiation code) in the above situation (which is not uncommon)?
Q2 Does the same advice apply regardless of the type of procedure/ where it is performed? For example, coronary angiogram performed in the cath lab or coiling of an aneurysm performed in the Radiology department or surgery performed in theatre?
Search Details:
The ICD Coding Newsletter in August 2000
ACS 1006
Total MV hours is 19. Should 13882-00 [569] Management of continuous ventilatory support <= 24 hours be assigned (as well as an initiation code)? ACS 1006 point 5 states:
'Assign a code for continuous ventilatory support for periods <= 24 hours ONLY when the ventilation is not performed during a procedure. For example, ventilation for <= 24 hours in intensive care after head injury or burns should be coded.
The ventilatory support that is provided to a patient during surgery is associated with anaesthesia and is considered an integral part of the surgical procedure and therefore ventilation of <= 24 hours should not be coded in these cases. However, CVS initiated during surgery and continuing for greater than 24 hours should be coded with duration beginning at the time of intraoperative intubation.'
It seems that coders interpret this standard in two different ways:
1) That because the initial ventilation was not for the initiation of a procedure/surgery that point 5 does not apply and that 13882-00 could be assigned in the above example.
2) That even though the ventilation was initiated for a reason other than initiation of a procedure/surgery (for example decreasing conscious state) that 13882-00 cannot be assigned because the patient was ventilated during the procedure/surgery and total MV hrs was less than 24..
The ICD Coding Newsletter in August 2000 states 'For coding periods of CVS of less than 24 hours, there is a difference between episodes separated:
- before 1 July 2000, when periods of CVS of less than 24 hours were not coded;
- on or after 1 July 2000, when periods of CVS of less than 24 hours are coded except when CVS is initiated for a surgical procedure'.
The confusion arises around the term 'during' in ACS 1006 ie 'Assign a code for continuous ventilatory support for periods <= 24 hours ONLY when the ventilation is not performed during a procedure'. Should 'during' be interpreted to mean 'for initiation of' a procedure?
Q1 Can you advise whether 13882-00 [569] Management of continuous ventilatory support <= 24 hours should be assigned (as well as an initiation code) in the above situation (which is not uncommon)?
Q2 Does the same advice apply regardless of the type of procedure/ where it is performed? For example, coronary angiogram performed in the cath lab or coiling of an aneurysm performed in the Radiology department or surgery performed in theatre?
Search Details:
The ICD Coding Newsletter in August 2000
ACS 1006
Response
The VICC advises that in accordance with point 5 of ACS 1006 Respiratory support, in this scenario it is correct to assign 13882-00 [569] Management of continuous ventilatory support <= 24 hours and 13857-00 [569] Continuous ventilatory support, initiation outside of intensive care unit because the patient was not intubated for the purpose of the procedure being performed.
In response to your second question, this advice applies to procedures performed both in and outside of theatre.
The VICC acknowledges that the term 'during' can be confusing and will forward this query to NCCH for consideration of clarifying the wording in point 5 of the ACS.
In response to your second question, this advice applies to procedures performed both in and outside of theatre.
The VICC acknowledges that the term 'during' can be confusing and will forward this query to NCCH for consideration of clarifying the wording in point 5 of the ACS.
