EmailACS 0012 Suspected Conditions and transfers
Publication Date: March 2014
ICD 10 AM Edition: Eighth edition
Query Number: 2876
Patient presents to Hospital A with chest pain. Having met admission criteria at Hospital A, the patient is transferred to Hospital B for CTPA with the transferring letter stating this is "to exclude PE" (pulmonary embolism) - note Hospital A does not have the equipment to perform this procedure. There is no documentation in the clinical notes other than chest pain.
Is the terminology "to exclude PE" synonymous with "? PE". That is, does a transfer to rule out a condition out mean it is suspected? In the scenario described does Hospital A code I26.9 Pulmonary embolism without mention of acute cor pulmonal
with Z75.3 Unavailability and inaccessibility of health-care facilities or R07.4 Chest pain?
Is the terminology "to exclude PE" synonymous with "? PE". That is, does a transfer to rule out a condition out mean it is suspected? In the scenario described does Hospital A code I26.9 Pulmonary embolism without mention of acute cor pulmonal
with Z75.3 Unavailability and inaccessibility of health-care facilities or R07.4 Chest pain?
Response
For the case cited, VICC advises that the correct code to assign is R07.4 Chest pain.
As ACS 0012 Suspected conditions under heading 'Transferred to another hospital' specifically refers to a suspected condition, VICC considers that there must be documentation in the record of 'suspected PE' or '?PE' in order for hospital A to assign a code for pulmonary embolism. VICC does not consider documentation of 'to exclude PE' to be synonymous with 'suspected PE'.
As ACS 0012 Suspected conditions under heading 'Transferred to another hospital' specifically refers to a suspected condition, VICC considers that there must be documentation in the record of 'suspected PE' or '?PE' in order for hospital A to assign a code for pulmonary embolism. VICC does not consider documentation of 'to exclude PE' to be synonymous with 'suspected PE'.
