Health data standards and systems

ACS 1808 Incontinence states "Incontinence is clinically significant when the incontinence: is not clinically considered to be physiologically normal, is not clinically considered to be developmentally normal, or is persistent in a patient with significant disability or mental retardation. Urinary and faecal incontinence codes R32, R15 should be assigned only when the incontinence is persistent prior to admission, is present at discharge or persists for at least seven days."

Victorians for many years now have adhered to this standard and have only assigned these codes when the above criteria has been met plus have required increased care. The increased care means that incontinence pads have been changed, bed linen changed, the patient has been cleaned from urine and faeces etc. At times multiple staff have been asked to assist in moving the patient to clean them up. We acknowledge that ACS 0002 Additional diagnoses reporting referred to in other standards does not list ACS 1808 Incontinence so incontinence must still meet ACS 0002 Additional diagnoses.

Coders would not assign the incontinence code for the occasional incontinence episode where a pad has been changed. This, according to ACS 1808 Incontinence is not clinically significant.

With the implementation of the Victorian additions to ACS 0002 Additional diagnoses, Point 3 states "Assignment of a code for the condition would not be justified when the condition receives routine care examples of routine care include but are not limited to: changing pads in a patient with known urinary incontinence." Therefore, from July 2017, Victorian coders will no longer be assigning incontinence codes based on criteria in ACS 1808 Incontinence and ACS 0002 Additional diagnoses.

ACS 0604 Stroke, part 2 Severity also talks about “conditions listed here would be coded routinely during the abstraction process.  However, note that for a stroke case, dysphagia, urinary and faecal incontinence, should only be coded when certain criteria are met”.  When you refer to the table in that standard it states that both urinary and faecal incontinence “should be assigned only when the incontinence is present at discharge or persists for at least 7 days.”
 
So we can see that ACS 1808 Incontinence and ACS 0604 Stroke talk about when incontinence is clinically significant and should be coded when it meets the criteria plus is shown to be managed during the episode (ACS 0002 Additional diagnoses).  Can the Committee please specify what more does a coder need to see before assigning incontinence codes?  When does VICC deem incontinence clinically significant?

Can the Committee please provide an example of when the urinary/faecal incontinence meets the criteria in ACS 1808 Incontinence and ACS 0002 Additional diagnoses?

VICC considers the changing of pads and bed linen for urinary and faecal incontinence to be routine care. Incontinence may be considered significant when there is documentation of a plan of care, review and management by an incontinence nurse or urologist, urodynamic testing, investigation into the cause of incontinence, or diagnostic or interventional procedures.

VICC acknowledges that the implementation of Vic 0002 Additional diagnoses will decrease the rate of incontinence being reported across Victoria.