EmailDiagnosis for same-day insertion of Reveal Loop Monitor
Publication Date: June 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3373
What should the principal diagnosis be for a patient who is admitted for insertion of a Reveal Loop Monitor?
Should it be the symptom/condition that is under investigation?
Should it be a Z code to indicate the admission was for the insertion of a device?
Example:
Patient with multiple strokes and recurrent dizziness. A Reveal device was implanted to look for underlying atrial fibrillation.
In line with VICC #2785 Principal diagnosis selection for for same-day TOE admissions (retired) it would appear that we should be coding the stroke and dizziness as principal diagnosis. However, unlike a TOE we do not get a result for the episode. The device recording is followed up about a month later as an outpatient and the outcome is not known at the time of coding. The episode is not treating a condition it is to insert a device to be used for diagnostic purposes.
Could you please provide advice on this to assist with consistency of coding in this area? Thank you for your assistance.
Search details:
VICC #2785 Principal diagnosis selection for same-day TOE admissions (retired)
VICC #3035 Removal of cardiac event monitor
I cannot find advice specific to the loop monitor.
Should it be the symptom/condition that is under investigation?
Should it be a Z code to indicate the admission was for the insertion of a device?
Example:
Patient with multiple strokes and recurrent dizziness. A Reveal device was implanted to look for underlying atrial fibrillation.
In line with VICC #2785 Principal diagnosis selection for for same-day TOE admissions (retired) it would appear that we should be coding the stroke and dizziness as principal diagnosis. However, unlike a TOE we do not get a result for the episode. The device recording is followed up about a month later as an outpatient and the outcome is not known at the time of coding. The episode is not treating a condition it is to insert a device to be used for diagnostic purposes.
Could you please provide advice on this to assist with consistency of coding in this area? Thank you for your assistance.
Search details:
VICC #2785 Principal diagnosis selection for same-day TOE admissions (retired)
VICC #3035 Removal of cardiac event monitor
I cannot find advice specific to the loop monitor.
Response
VICC agrees that the reveal loop monitor is inserted for diagnostic purposes, rather than for treatment purposes, however VICC does not consider it appropriate to assign a code from the Z40-Z54 range of codes in cases where a device is being inserted to aid in diagnosis.
This is in accordance with the note at the beginning of the Z40-Z54 range of codes which states: 'Categories Z40–Z54 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving follow-up or prophylactic care, convalescent care, or care to consolidate the treatment, to deal with residual states, to ensure that the condition has not recurred, or to prevent recurrence.'
In the example cited, VICC suggests to assign the principal diagnosis in accordance with documentation of the reason for the procedure and ACS 0001 Principal diagnosis. In your example, stroke and dizziness would be assigned with sequencing according to ACS 0001 Principal diagnosis.
This is in accordance with the note at the beginning of the Z40-Z54 range of codes which states: 'Categories Z40–Z54 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving follow-up or prophylactic care, convalescent care, or care to consolidate the treatment, to deal with residual states, to ensure that the condition has not recurred, or to prevent recurrence.'
In the example cited, VICC suggests to assign the principal diagnosis in accordance with documentation of the reason for the procedure and ACS 0001 Principal diagnosis. In your example, stroke and dizziness would be assigned with sequencing according to ACS 0001 Principal diagnosis.
