EmailACS 1615 Specific interventions for the sick neonate and parenteral fluid therapy
Publication Date: March 2013
ICD 10 AM Edition: Seventh edition
Retired Date: 30/6/2017
Query Number: 2761
We would like to seek clarification of the following statement regarding the assignment of intervention codes for parenteral fluid therapy as outlined in ACS 1615 Specific interventions for the sick neonate and parenteral fluid therapy:
“...Should be assigned when used for management of carbohydrate, hydration or electrolyte disorders”.
We have sought clarification from a paediatrician who provided the following information:
IV fluids are used for:
• Carbohydrates - control of blood sugars
• Hydration - in babies not able to tolerate oral feeds or with respiratory distress or other conditions where feeding is not considered safe
• Electrolyte Balance - essentially neonates not able to feed after first day
• Resuscitation - intravenous saline to improve baby's blood pressure or circulation
1. Is documentation of a carbohydrate, hydration or electrolyte disorder and documented administration of parenteral fluid therapy sufficient to suggest the condition was managed, or do you require a direct link provided within the clinical documentation?
2. Is the administration of parenteral fluid for ‘other’ reasons, sufficient to assign a code for parenteral fluid therapy? That is, the fluid could be given to prevent the neonate from developing a carbohydrate, hydration or electrolyte disorder which has not yet developed. For example, Feeding Establishment -currently on IV Dextrose 30mls
“...Should be assigned when used for management of carbohydrate, hydration or electrolyte disorders”.
We have sought clarification from a paediatrician who provided the following information:
IV fluids are used for:
• Carbohydrates - control of blood sugars
• Hydration - in babies not able to tolerate oral feeds or with respiratory distress or other conditions where feeding is not considered safe
• Electrolyte Balance - essentially neonates not able to feed after first day
• Resuscitation - intravenous saline to improve baby's blood pressure or circulation
1. Is documentation of a carbohydrate, hydration or electrolyte disorder and documented administration of parenteral fluid therapy sufficient to suggest the condition was managed, or do you require a direct link provided within the clinical documentation?
2. Is the administration of parenteral fluid for ‘other’ reasons, sufficient to assign a code for parenteral fluid therapy? That is, the fluid could be given to prevent the neonate from developing a carbohydrate, hydration or electrolyte disorder which has not yet developed. For example, Feeding Establishment -currently on IV Dextrose 30mls
Response
VICC’s understanding is that the parental fluid therapy codes were created to inform DRG development and that it is common practice to assign these codes when the intervention is performed.
VICC is aware that in Eighth Edition the NCCC has changed the standard so that the intervention codes sit under the heading of ‘Code always when performed’, however has retained the instruction ‘when used for management of carbohydrate, hydration or electrolyte disorders’.
VICC therefore does not consider that there must be documentation of carbohydrate, hydration or electrolyte disorders in order to assign the parental fluid therapy codes and therefore supports the assignment of these codes when the intervention is performed.
VICC will send a public submission to NCCC asking that consideration be given to removing the instruction ‘when used for management of carbohydrate, hydration or electrolyte disorders’.
VICC is aware that in Eighth Edition the NCCC has changed the standard so that the intervention codes sit under the heading of ‘Code always when performed’, however has retained the instruction ‘when used for management of carbohydrate, hydration or electrolyte disorders’.
VICC therefore does not consider that there must be documentation of carbohydrate, hydration or electrolyte disorders in order to assign the parental fluid therapy codes and therefore supports the assignment of these codes when the intervention is performed.
VICC will send a public submission to NCCC asking that consideration be given to removing the instruction ‘when used for management of carbohydrate, hydration or electrolyte disorders’.
