EmailACS 0003 Supplementary codes for chronic conditions
Publication Date: December 2015
ICD 10 AM Edition: Ninth edition
Query Number: 3072
ACS 0003 states that U codes for chronic conditions are only to be assigned where it is evident that the condition is part of the current health status of the patient. We have taken this to mean that if a condition is incurable it can be assigned a U code. To avoid coders having to make this decision we have put together the following list of conditions that our research indicates cannot be cured (which has been confirmed by a clinician). The conditions listed as can be cured or unclear require the coder to confirm that they are current.
Cannot be cured:
CF, Schizophrenia, Disorders of intellectual development (with the exception of developmental delay), Parkinson's, MS, CP IHD, Chronic heart failure (except by transplant), Emphysema, COPD, Asthma, Bronchiectasis, Crohn's disease, RA, OA, SLE (but can have periods of remission), OP, CKD, Spina bifida, Down's syndrome, Dementia documented as Alzheimer's
Can be cured, therefore you need to find further information that this is a current condition:
Epilepsy, Obesity, Plegias Ulcerative colitis
Unclear, therefore you need to find further information that this is a current condition:
Depression, Dementia not documented as Alzheimer's, HT not documented as essential, Chronic respiratory failure (unlikely to be cured but depends on underlying cause. Possible cure by transplant), Chronic liver failure (unlikely to be cured but possibly by transplant)
This query was sent to ACCD but didn't appear in the FAQs.
1.Do you support this approach?
2.The advice in ACCD Coding Rule TN907 appears contradictory as it says that where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code. But in the example given a U code is assigned for hypertension even though there is no evidence that it is a current condition. Should hypertension always be coded when documented?
Where a patient episode is documented with a past medical history of hypertension, IHD and OA, all of these conditions should qualify. However, where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code.
3.In the example in Coding Rule TN907 a U code has not been assigned for asthma as it has not occurred since the patient was a teenager. However, the Asthma Foundation website says that asthma is incurable. What evidence do coders need to look for in order to determine that asthma is part of the current health status?
4.Coding Rules also state that not all chronic conditions are managed with ongoing medication and so it is not necessary to review medication charts to inform code assignment. Some coders are looking up medications to verify whether a chronic condition is current (eg documentation of hypertension in notes and Coversyl listed on medication chart, but not documented as the treatment for HT). Can we make the link between a drug (whether or not on a medication chart) and a condition to allow assignment of a U code, e.g. U82.3 Hypertension?
Search Details:
ACCD Coding Rules Ref No:TN907, Published 15 Sept 2015
SUBJECT: ACS 0003 Supplementary codes for chronic conditions
Q:
What documentation can be used to assign supplementary codes for chronic conditions (U codes)?
Q:
Do conditions listed under the heading of past history or background/problems qualify?
Q:
Do conditions need to be medicated to prove they are current?
A:
Clinicians may use the heading past history to represent conditions or procedures etc. occurring in the past, including the recent past. Therefore, conditions listed under such headings may be part of the current health status of the patient and should not be excluded based on the heading. However, conditions listed in previous admissions and correspondence, but not listed in the current episode of care are not to be used (as per Coding Rule Coding from documentation in previous admissions).
Not all chronic conditions are managed with ongoing medication and so it is not necessary to review medication charts to inform code assignment. ACS example 5 highlights asthma as a child with no further documentation as to its relevance for the adult.
Where a patient episode is documented with a past medical history of hypertension, IHD and OA, all of these conditions should qualify. However, where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code.
In the example above, a U code would only be assigned for hypertension as childhood asthma has not occurred since a teenager and ischaemic heart disease is only queried.
Cannot be cured:
CF, Schizophrenia, Disorders of intellectual development (with the exception of developmental delay), Parkinson's, MS, CP IHD, Chronic heart failure (except by transplant), Emphysema, COPD, Asthma, Bronchiectasis, Crohn's disease, RA, OA, SLE (but can have periods of remission), OP, CKD, Spina bifida, Down's syndrome, Dementia documented as Alzheimer's
Can be cured, therefore you need to find further information that this is a current condition:
Epilepsy, Obesity, Plegias Ulcerative colitis
Unclear, therefore you need to find further information that this is a current condition:
Depression, Dementia not documented as Alzheimer's, HT not documented as essential, Chronic respiratory failure (unlikely to be cured but depends on underlying cause. Possible cure by transplant), Chronic liver failure (unlikely to be cured but possibly by transplant)
This query was sent to ACCD but didn't appear in the FAQs.
1.Do you support this approach?
2.The advice in ACCD Coding Rule TN907 appears contradictory as it says that where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code. But in the example given a U code is assigned for hypertension even though there is no evidence that it is a current condition. Should hypertension always be coded when documented?
Where a patient episode is documented with a past medical history of hypertension, IHD and OA, all of these conditions should qualify. However, where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code.
3.In the example in Coding Rule TN907 a U code has not been assigned for asthma as it has not occurred since the patient was a teenager. However, the Asthma Foundation website says that asthma is incurable. What evidence do coders need to look for in order to determine that asthma is part of the current health status?
4.Coding Rules also state that not all chronic conditions are managed with ongoing medication and so it is not necessary to review medication charts to inform code assignment. Some coders are looking up medications to verify whether a chronic condition is current (eg documentation of hypertension in notes and Coversyl listed on medication chart, but not documented as the treatment for HT). Can we make the link between a drug (whether or not on a medication chart) and a condition to allow assignment of a U code, e.g. U82.3 Hypertension?
Search Details:
ACCD Coding Rules Ref No:TN907, Published 15 Sept 2015
SUBJECT: ACS 0003 Supplementary codes for chronic conditions
Q:
What documentation can be used to assign supplementary codes for chronic conditions (U codes)?
Q:
Do conditions listed under the heading of past history or background/problems qualify?
Q:
Do conditions need to be medicated to prove they are current?
A:
Clinicians may use the heading past history to represent conditions or procedures etc. occurring in the past, including the recent past. Therefore, conditions listed under such headings may be part of the current health status of the patient and should not be excluded based on the heading. However, conditions listed in previous admissions and correspondence, but not listed in the current episode of care are not to be used (as per Coding Rule Coding from documentation in previous admissions).
Not all chronic conditions are managed with ongoing medication and so it is not necessary to review medication charts to inform code assignment. ACS example 5 highlights asthma as a child with no further documentation as to its relevance for the adult.
Where a patient episode is documented with a past medical history of hypertension, IHD and OA, all of these conditions should qualify. However, where it is unclear if the condition is continuing in the patient, follow the guidelines in ACS 0003 Supplementary codes for chronic conditions and do not assign a U code.
In the example above, a U code would only be assigned for hypertension as childhood asthma has not occurred since a teenager and ischaemic heart disease is only queried.
Response
VICC cannot support the approach detailed in the query as in order for a supplementary code for chronic conditions to be assigned, the condition must be documented in the episode and the condition must also be indexed under the Lead term Supplementary codes. The decision to assign a code must be based on documentation of the condition rather than a list.
Errata 3 for Ninth Edition includes an additional sentence to ACS 0003 Supplementary codes for chronic conditions which says 'the U codes represent chronic conditions that may be assumed to be current unless there is documentation that indicates otherwise'.
Refer also to VICC query #3046 U code for overweight for further information on coding of supplementary codes for chronic conditions.
Errata 3 for Ninth Edition includes an additional sentence to ACS 0003 Supplementary codes for chronic conditions which says 'the U codes represent chronic conditions that may be assumed to be current unless there is documentation that indicates otherwise'.
Refer also to VICC query #3046 U code for overweight for further information on coding of supplementary codes for chronic conditions.
