EmailACS 0012 Suspected conditions
Publication Date: December 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3398
The opening statement of ACS 0012 Suspected conditions mentions 'terms that indicate uncertainty about the final diagnosis (such as probable, suspected, possible, likely, query, ?) or other similar qualifying expressions'. There is no mention of differential diagnoses.
Can the VICC please advise what should be coded when there is documentation of both a suspected condition and a differential diagnosis?
We are unsure of how to apply ACS 0012 to the following case:
Diagnosis on Discharge Summary: Fever/ nausea/ high stomal output
- Probable gastroenteritis. Differential Dx exacerbation of usual high stoma output
In this case should we code the symptoms or the gastroenteritis?
The dot point under example 2 in ACS 0012 states: 'if more than one suspected condition is documented as the differential diagnosis:
assign code(s) for the documented symptom(s)
OR
if there are no symptom(s) documented, assign codes for all suspected conditions.'
If no symptoms are documented why not follow the advice on observation for suspected diseases and conditions (Z03.0 - Z03.9) in the same standard and assign Z codes?
We note the Errata 3 change to ACS 0012 and the instruction that if there are no symptoms documented to code all suspected conditions. We are wondering why the advice on observation for suspected diseases and conditions (Z03.0 - Z03.9) that is in the same standard is not followed and Z codes assigned instead?
Can the VICC please advise what should be coded when there is documentation of both a suspected condition and a differential diagnosis?
We are unsure of how to apply ACS 0012 to the following case:
Diagnosis on Discharge Summary: Fever/ nausea/ high stomal output
- Probable gastroenteritis. Differential Dx exacerbation of usual high stoma output
In this case should we code the symptoms or the gastroenteritis?
The dot point under example 2 in ACS 0012 states: 'if more than one suspected condition is documented as the differential diagnosis:
assign code(s) for the documented symptom(s)
OR
if there are no symptom(s) documented, assign codes for all suspected conditions.'
If no symptoms are documented why not follow the advice on observation for suspected diseases and conditions (Z03.0 - Z03.9) in the same standard and assign Z codes?
We note the Errata 3 change to ACS 0012 and the instruction that if there are no symptoms documented to code all suspected conditions. We are wondering why the advice on observation for suspected diseases and conditions (Z03.0 - Z03.9) that is in the same standard is not followed and Z codes assigned instead?
Response
VICC considers that the term differential is an example of a qualifying expression that indicates uncertainty about a final diagnosis, and therefore diagnoses on the discharge summary that have been documented as differential should be classified in the same way as suspected conditions.
In the scenario cited, VICC advises to assign a code for each of the documented symptoms of fever, nausea, and high stomal output in accordance with the amended (Errata 3) ACS 0012 Suspected conditions where it states 'if more than one suspected condition is documented as the differential diagnosis, assign code(s) for the documented symptoms'.
In the rare circumstance where there is more than one suspected condition but no symptoms documented, follow the amended (Errata 3) ACS 0012 Suspected conditions where it states 'if there are no symptoms documented, assign a code for all suspected conditions'.
ACS 0012 Suspected conditions - Observation for suspected diseases and conditions (Z03.0-Z03.9) applies to situations where no supporting evidence for the suspected condition is found and no treatment is currently required.
In the scenario cited, VICC advises to assign a code for each of the documented symptoms of fever, nausea, and high stomal output in accordance with the amended (Errata 3) ACS 0012 Suspected conditions where it states 'if more than one suspected condition is documented as the differential diagnosis, assign code(s) for the documented symptoms'.
In the rare circumstance where there is more than one suspected condition but no symptoms documented, follow the amended (Errata 3) ACS 0012 Suspected conditions where it states 'if there are no symptoms documented, assign a code for all suspected conditions'.
ACS 0012 Suspected conditions - Observation for suspected diseases and conditions (Z03.0-Z03.9) applies to situations where no supporting evidence for the suspected condition is found and no treatment is currently required.
