EmailACS 0012 Suspected conditions
Publication Date: September 2015
ICD 10 AM Edition: Eighth edition
Retired Date: 30/6/2020
Query Number: 2824
There is some confusion over when to apply point 3 of ACS 0012 Suspected conditions. If investigations were undertaken and the results indicated a probable diagnosis, yet no specific treatment was initiated during the episode of care, assign a code for the suspected condition.
Our issue is that some interpret the wording of a probable diagnosis to mean any of the terms indicating uncertainty that are mentioned at the beginning of the standard probable, suspected, possible. Whereas others interpret this to mean that you need the documentation of a term which indicates more certainty about the diagnosis such as probable or likely rather than suspected or possible.
If the consensus is that it can include any of the terms mentioned within the standard, can you please clarify how point 3 of the standard differs from point 1.
Can you also please provide advice on what would be coded and what part of the standard would be applied for the following cases?
CASE 1
Diagnosis on discharge: # L) arm paraesthesia FI ? Conversion disorder
Investigations: CTB/c spine, MRI brain all normal
Neurology and psychiatry reviews
Treatment: Nil
Follow up with GP in 1/52 for review
CASE 2
Diagnosis on discharge: PR bleed and lower abdo pain - Possible colitis
Investigations: Bloods NAD Abdo ultrasound NAD
Treatment : Morphine & Buscopan
Follow up: GP follow up in one week to chase faecal specimen culture
CASE 3
Diagnosis on discharge: ? Ruptured ovarian cyst L)IF pain
Investigations: Bloods NAD Pelvic U/S some fluid seen around the ovary, rupture of ovarian cyst suspected
Treatment: Morphine
Follow up : Referral made to gynaecologist
Our issue is that some interpret the wording of a probable diagnosis to mean any of the terms indicating uncertainty that are mentioned at the beginning of the standard probable, suspected, possible. Whereas others interpret this to mean that you need the documentation of a term which indicates more certainty about the diagnosis such as probable or likely rather than suspected or possible.
If the consensus is that it can include any of the terms mentioned within the standard, can you please clarify how point 3 of the standard differs from point 1.
Can you also please provide advice on what would be coded and what part of the standard would be applied for the following cases?
CASE 1
Diagnosis on discharge: # L) arm paraesthesia FI ? Conversion disorder
Investigations: CTB/c spine, MRI brain all normal
Neurology and psychiatry reviews
Treatment: Nil
Follow up with GP in 1/52 for review
CASE 2
Diagnosis on discharge: PR bleed and lower abdo pain - Possible colitis
Investigations: Bloods NAD Abdo ultrasound NAD
Treatment : Morphine & Buscopan
Follow up: GP follow up in one week to chase faecal specimen culture
CASE 3
Diagnosis on discharge: ? Ruptured ovarian cyst L)IF pain
Investigations: Bloods NAD Pelvic U/S some fluid seen around the ovary, rupture of ovarian cyst suspected
Treatment: Morphine
Follow up : Referral made to gynaecologist
Response
VICC referred this query to ACCD who has acknowledged some ambiguity in the standard but would like to maintain the status quo for Eighth and Ninth Edition rather than publish advice that could result in a major change to current coding practice. Instead ACCD has created a task to review the standard and welcomes a Public Submission on this subject.
VICC considers that the terms in ACS 0012 Suspected conditions listed under the heading of Discharged home are interchangeable. VICC also considers that the difference between example 1 and example 3 in the standard is that example 3 illustrates a condition for which there is no treatment.
With respect to the examples in the query, VICC acknowledges the difficulty in interpreting whether treatment was given for the condition and advises to seek clinical clarification if there is capacity to do so. VICC further considers it is not the role of the coder to determine whether treatment has been given for a specific condition. If the documentation does not support the decision to code the condition, VICC advises to default to coding the symptom.
VICC also suggests to consider ACS 1802 Signs and Symptoms and ACS 0001 Principal diagnosis when making a decision.
VICC considers that the terms in ACS 0012 Suspected conditions listed under the heading of Discharged home are interchangeable. VICC also considers that the difference between example 1 and example 3 in the standard is that example 3 illustrates a condition for which there is no treatment.
With respect to the examples in the query, VICC acknowledges the difficulty in interpreting whether treatment was given for the condition and advises to seek clinical clarification if there is capacity to do so. VICC further considers it is not the role of the coder to determine whether treatment has been given for a specific condition. If the documentation does not support the decision to code the condition, VICC advises to default to coding the symptom.
VICC also suggests to consider ACS 1802 Signs and Symptoms and ACS 0001 Principal diagnosis when making a decision.
