EmailACS 1908 Laceration with nerve and tendon damage
Publication Date: December 2011
ICD 10 AM Edition: Seventh edition
Retired Date: 30/6/2017
Query Number: 2664
ACS 1908 Laceration with nerve and tendon damage
We have differences in opinion on how this standard is applied. Our question is in regards to the paragraph:
Open wound with arterial and nerve damage
The standard states: 'The overriding factor in a vascular injury is the potential of limb loss or compromise. In these instances where arterial and nerve damage may occur together, priority should be given to sequencing arterial damage first followed by nerve damage, followed by laceration. Where there is no potential for loss of limb, yet both nerve and artery damage have occurred, the clinician should be consulted as to the correct sequencing.'
1. When a patient is admitted with arterial and nerve damage, can we assign the arterial damage as principal diagnosis? (i.e default to artery injury as the principal diagnosis) Or do we need documentation in the record that there is potential for limb loss in order to routinely assign the arterial damage first if nerve damage is also present?
2. We often query cases with our clinicans to ascertain if the arterial damage has the potential for limb loss. In the majority of cases the answer is no. Does this mean that if there is no potential for limb loss we cannot assign the arterial injury first and have to code the nerve injury as the principal diagnosis?
We have differences in opinion on how this standard is applied. Our question is in regards to the paragraph:
Open wound with arterial and nerve damage
The standard states: 'The overriding factor in a vascular injury is the potential of limb loss or compromise. In these instances where arterial and nerve damage may occur together, priority should be given to sequencing arterial damage first followed by nerve damage, followed by laceration. Where there is no potential for loss of limb, yet both nerve and artery damage have occurred, the clinician should be consulted as to the correct sequencing.'
1. When a patient is admitted with arterial and nerve damage, can we assign the arterial damage as principal diagnosis? (i.e default to artery injury as the principal diagnosis) Or do we need documentation in the record that there is potential for limb loss in order to routinely assign the arterial damage first if nerve damage is also present?
2. We often query cases with our clinicans to ascertain if the arterial damage has the potential for limb loss. In the majority of cases the answer is no. Does this mean that if there is no potential for limb loss we cannot assign the arterial injury first and have to code the nerve injury as the principal diagnosis?
Response
ACS 1908 Laceration with nerve and tendon damage under section 'open wound with arterial and nerve damage' provides advice on sequencing when there is documented potential for limb loss or compromise. When there is no documented potential for limb loss or compromise the standard advises coders to consult with the clinician for correct sequencing.
VICC advises that if you are unable to consult a clinician, code as the principal diagnosis the first mentioned diagnosis on the discharge summary as per advice in ACS 0001 Principal diagnosis under section 'two or more diagnoses that equally meet the definition for principal diagnosis'.
VICC advises that if you are unable to consult a clinician, code as the principal diagnosis the first mentioned diagnosis on the discharge summary as per advice in ACS 0001 Principal diagnosis under section 'two or more diagnoses that equally meet the definition for principal diagnosis'.
