EmailACS 1103 Gastrointestinal (GI) haemorrhage
Publication Date: June 2013
ICD 10 AM Edition: Seventh edition
Retired Date: 30/6/2017
Query Number: 2779
Could you please provide some guidance re the use of 'with haemorrhage' as per ACS 1103. The wording in the standard is very specific: 'upper GI bleeding', 'ulcer, erosions, varices'; how strictly is this wording to be adhered to?
1) Can PR bleeding be regarded in the same way as upper GI bleeding as per VICC query 2512?
2) Can FOB+ve be regarded in this way also? (Eg indication for colonoscopy is FOB+ve, Operative Diagnosis is diverticular disease, should this be coded as diverticular disease with haemorrhage?)
3) Can any finding be coded to as 'with haemorrhage' as diverticular disease is in VICC query 2512 (eg, it is not an 'ulcer, erosion or varices' specifically)?
We feel ACS 1103 may be worded too specifically if the intent is to apply it to all endoscopy cases where bleeding is present and a finding is documented in the Operative Diagnosis on the Operation Report, as per the example in VICC query 2512. Perhaps ACS 1103 should be looked at for potential re-wording for 8th edition?
Search details:
ACS 1103
VICC query 2512
1) Can PR bleeding be regarded in the same way as upper GI bleeding as per VICC query 2512?
2) Can FOB+ve be regarded in this way also? (Eg indication for colonoscopy is FOB+ve, Operative Diagnosis is diverticular disease, should this be coded as diverticular disease with haemorrhage?)
3) Can any finding be coded to as 'with haemorrhage' as diverticular disease is in VICC query 2512 (eg, it is not an 'ulcer, erosion or varices' specifically)?
We feel ACS 1103 may be worded too specifically if the intent is to apply it to all endoscopy cases where bleeding is present and a finding is documented in the Operative Diagnosis on the Operation Report, as per the example in VICC query 2512. Perhaps ACS 1103 should be looked at for potential re-wording for 8th edition?
Search details:
ACS 1103
VICC query 2512
Response
VICC notes that ACS 1103 Gastrointestinal (GI) haemorrhage was not applied in VICC #2512 Operative diagnosis and symptom for same day endoscopy to make a link between the PR bleeding and the diverticular disease; the documentation in that query supported a link between the operative diagnosis and the presenting symptom. ACS 1103 was referenced to provide advice for coding conditions that do not have the 'with haemorrhage' distinction included in the code.
In answer to your specific questions:
1. PR bleeding cannot be regarded in the same way as upper GI bleeding as ACS 1103 Gastrointestinal (GI) haemorrhage differentiates on how upper and lower GI bleeding should be coded.
2. As FOB detects tiny amounts of blood, it is not the same as haemorrhage, therefore a +ve FOB cannot be coded as a haemorrhage. This is supported by Index entry Positive, faecal occult blood R19.5 Other faecal abnormalities.
3. No, as noted above there needs to be a causal link made between the finding and the bleeding. In #2512 this link was made by the documentation, that is, the operative diagnosis was diverticular disease and the symptom was bleeding. ‘Any finding’ cannot be assumed to be the cause of the haemorrhage. ACS 0046 and ACS 1103 need to be applied to the documentation used and a decision made as to whether a causal link has been given or implied before assigning a ‘with haemorrhage’ code.
Query #2512 was retired on 1 January 2014. Please refer to #2880 Principal diagnosis in same day endoscopy cases.
In answer to your specific questions:
1. PR bleeding cannot be regarded in the same way as upper GI bleeding as ACS 1103 Gastrointestinal (GI) haemorrhage differentiates on how upper and lower GI bleeding should be coded.
2. As FOB detects tiny amounts of blood, it is not the same as haemorrhage, therefore a +ve FOB cannot be coded as a haemorrhage. This is supported by Index entry Positive, faecal occult blood R19.5 Other faecal abnormalities.
3. No, as noted above there needs to be a causal link made between the finding and the bleeding. In #2512 this link was made by the documentation, that is, the operative diagnosis was diverticular disease and the symptom was bleeding. ‘Any finding’ cannot be assumed to be the cause of the haemorrhage. ACS 0046 and ACS 1103 need to be applied to the documentation used and a decision made as to whether a causal link has been given or implied before assigning a ‘with haemorrhage’ code.
Query #2512 was retired on 1 January 2014. Please refer to #2880 Principal diagnosis in same day endoscopy cases.
