EmailACS 1808 Incontinence
Publication Date: December 2009
ICD 10 AM Edition: Sixth edition
Retired Date: 30/6/2015
Query Number: 2464
We have many patients admitted to our hospital with evidence of incontinence written in the notes.
The following are cases in one of our audits, which have prompted these queries to you.
1.Patient with dementia, who has documentation on the bowel charts of incont/cont for the whole admission, and has IDC for atonic bladder. Can a code for faecal incontinence be assigned?
2. Elderly patient with documentation on the progress notes in ED (from nursing home letter accompanying patient) of continent when taken to toilet regularly but otherwise incontinent (wears pads). No bowel chart, notes just have 'BO'. Can a code be assigned for urine incontinence?
3. Patient with Wernicke's encephalopathy who has documented on the nursing care plan against Elimination - 'Urine, cont/incont' for 8 days in a row, then 4 days of - 'Urine, cont'. Can a code be assigned for urinary incontinence?
4. Patient admitted confused, unable to give history. Daughter states patient had been faecally incontinent for 3 months, and unable to cope. Bowel chart has documentation of cont/incont for every entry for the 6 day stay. Does the incontinence in this case meet the definition of 'persistent prior to admission'?
The following are cases in one of our audits, which have prompted these queries to you.
1.Patient with dementia, who has documentation on the bowel charts of incont/cont for the whole admission, and has IDC for atonic bladder. Can a code for faecal incontinence be assigned?
2. Elderly patient with documentation on the progress notes in ED (from nursing home letter accompanying patient) of continent when taken to toilet regularly but otherwise incontinent (wears pads). No bowel chart, notes just have 'BO'. Can a code be assigned for urine incontinence?
3. Patient with Wernicke's encephalopathy who has documented on the nursing care plan against Elimination - 'Urine, cont/incont' for 8 days in a row, then 4 days of - 'Urine, cont'. Can a code be assigned for urinary incontinence?
4. Patient admitted confused, unable to give history. Daughter states patient had been faecally incontinent for 3 months, and unable to cope. Bowel chart has documentation of cont/incont for every entry for the 6 day stay. Does the incontinence in this case meet the definition of 'persistent prior to admission'?
Response
The NCCH provided the following response in relation to this query:
"Follow the advice published in 10-AM Commandments of Coding Matters, Vol 16, No 1, which states:
R32 Unspecified urinary incontinence and R15 Faecal incontinence should be assigned if they meet the criteria in ACS 0001 Principal diagnosis or ACS 0002 Additional diagnoses.
Additionally, advice in ACS 1808 Incontinence should be followed. ACS 1808 specifies that 'persistent' faecal and/or urinary incontinence should be coded, ie 'persistent prior to admission, is present at discharge or persists for at least seven days.'
In scenarios 1, 3 and 4 incontinence should be coded, but in scenario 2 evidence of incontinence is unclear. Documentation of incontinence in the current episode of care, would be required for code assignment.
ACS 1808 Incontinence has been flagged for review for a future edition of the ACS."
"Follow the advice published in 10-AM Commandments of Coding Matters, Vol 16, No 1, which states:
R32 Unspecified urinary incontinence and R15 Faecal incontinence should be assigned if they meet the criteria in ACS 0001 Principal diagnosis or ACS 0002 Additional diagnoses.
Additionally, advice in ACS 1808 Incontinence should be followed. ACS 1808 specifies that 'persistent' faecal and/or urinary incontinence should be coded, ie 'persistent prior to admission, is present at discharge or persists for at least seven days.'
In scenarios 1, 3 and 4 incontinence should be coded, but in scenario 2 evidence of incontinence is unclear. Documentation of incontinence in the current episode of care, would be required for code assignment.
ACS 1808 Incontinence has been flagged for review for a future edition of the ACS."
