EmailACS 0920 Acute Pulmonary Oedema
Publication Date: June 2015
ICD 10 AM Edition: Eighth edition
Retired Date: 31/5/2023
Query Number: 2996
We have been reviewing our PICQ data and have come up with some questions relating to the coding of Acute Pulmonary Oedema which is causing us some confusion.
1) The standard states that if the underlying cause is not known then we should code I50.1 Left ventricular failure, however if we do have an underlying cause such as pulmonary hypertension should we then code J81 Pulmonary oedema?
2 a) Are there instances where the underlying cause would mean that I50.1 should be used, such as cardiomyopathy being the underlying cause?
b) Is APO on a background of COAD enough for us to consider this an underlying cause and assign J81?
3) Additionally if a patient is documented as having 'pulmonary oedema' with no qualification that it is 'acute' does ACS 0920 still apply?
1) The standard states that if the underlying cause is not known then we should code I50.1 Left ventricular failure, however if we do have an underlying cause such as pulmonary hypertension should we then code J81 Pulmonary oedema?
2 a) Are there instances where the underlying cause would mean that I50.1 should be used, such as cardiomyopathy being the underlying cause?
b) Is APO on a background of COAD enough for us to consider this an underlying cause and assign J81?
3) Additionally if a patient is documented as having 'pulmonary oedema' with no qualification that it is 'acute' does ACS 0920 still apply?
Response
In answer to question 1, if the underlying cause is a heart condition or failure, VICC advises to follow the Index entry Oedema/lung/with heart condition or failure (see also Failure/ventricular/left) and assign I50.1 Left ventricular failure. This is supported by the excludes note at J81 Pulmonary oedema which says 'excludes pulmonary oedema with mention of heart disease or heart failure'. VICC considers pulmonary hypertension to be a cardiac condition as it is classified to Pulmonary heart disease and diseases of pulmonary circulation and would therefore assign I50.1. If however, the known underlying condition is not a heart condition or failure, assign J81.
In answer to question 2a, if cardiomyopathy has been identified as the underlying cause of the acute pulmonary oedema, as per the Index entry above, it is correct to assign I50.1 Left ventricular failure. In answer to question 2b, VICC considers that 'on a background of' is not the same as underlying cause, therefore follow ACS 0920 and assign I50.1.
In answer to question 3, ACS 0920 does not apply if the qualifying term 'acute' is not documented. Therefore you would follow Index entry Oedema/lung (acute) to assign the appropriate code according to your documentation.
Note: This query has been retired due to the retirement of ACS 0920 Acute pulmonary oedema in Twelfth Edition and the relocation of the content to ICD-10-AM Tabular List and Alphabetic Index.
In answer to question 2a, if cardiomyopathy has been identified as the underlying cause of the acute pulmonary oedema, as per the Index entry above, it is correct to assign I50.1 Left ventricular failure. In answer to question 2b, VICC considers that 'on a background of' is not the same as underlying cause, therefore follow ACS 0920 and assign I50.1.
In answer to question 3, ACS 0920 does not apply if the qualifying term 'acute' is not documented. Therefore you would follow Index entry Oedema/lung (acute) to assign the appropriate code according to your documentation.
Note: This query has been retired due to the retirement of ACS 0920 Acute pulmonary oedema in Twelfth Edition and the relocation of the content to ICD-10-AM Tabular List and Alphabetic Index.
