EmailACS 0002 and increased clinical care
Publication Date: June 2020
Implementation Date: 1/07/2020
ICD 10 AM Edition: Eleventh Edition
Query Number: 3658
Many thanks for considering these issues for us.
Firstly:
1.Is the VAHI 11th Edition ICD-10-AM/ACHI/ACS Victorian Education document still to be used by Victorian Coders as a supplement to ACS 0002, since the release of Errata 3 amendments to ACS 0002 (for implementation 1st January 2020)?
If so, we would like clarification in regards to this particular point regarding the Increased Clinical Care section and condition significance; where the VAHI document differs slightly to the ACS 0002 update.
Conditions are significant in an episode of care when clinical care provided for a condition is beyond routine (i.e. increased clinical care). Examples of increased clinical care include:
• providing care for a condition that is in excess of the routine care that would normally be provided by medical officer/nursing/allied health for that condition (e.g. documented evidence that the patient with dementia requires increased observation due to fluctuation in behaviour, cognition and physical condition)
• receiving clinical consultation for a condition with documentation of a clinical assessment, a diagnostic statement, or a care plan for the condition (e.g. patient referral to an oncologist for cancer assessment with documentation of advice received; wound specialist/nurse assessment of pressure injury with documentation of staging of pressure injury and care plan). Note that a care plan may include an adjustment to, or continuation of, the current treatment plan, or transfer to another facility with documentation of the reason(s) for transfer
• performance of a therapeutic intervention for a condition (e.g. dialysis for end-stage renal failure, pharmacotherapy for multiple sclerosis)
• pre and postoperative management in excess of routine care (see also ACS 1904 Procedural complications)
The sentence in the above point “receiving clinical consultation for a condition with documentation of assessment, a diagnostic statement OR a care plan for the condition”, implies a condition can be coded if it meets ANY of the criteria listed in the sentence (clinical assessment, a diagnosis, care plan).
However, the update to 0002 has been reworded, and though similar, the associated sentence here has been extrapolated out to dot-points that are followed by “AND”, implying that ALL three documentation points must be met (assessment + diagnosis+ care plan).
Conditions are significant in an episode of care when clinical care provided for a condition is beyond routine (i.e. increased clinical care). Examples of increased clinical care include:
•providing care for a condition that is in excess of the routine care that would normally be provided by medical officer/nursing/allied health for that condition (eg documented evidence that the patient with dementia requires increased observation due to fluctuation in behaviour, cognition and physical condition)
•receiving clinical consultation for a condition with documentation of:
o a clinical assessment, and
o a diagnosis, and,
o a care plan for the condition (eg patient referral to an oncologist for cancer assessment with documentation of advice received; wound specialist/nurse assessment of pressure injury with documentation of staging of pressure injury and care
2.Should we apply the AND logic in the ACS 0002? Or for example, where there is consultation from another specialty or discipline, is this alone enough to meet criteria for Increased Clinical Care (assessment only)?
Examples:
•Methadone dependent patient seen by APS with documentation of ‘usually on meth 25mg daily go back to normal meth dose in a few weeks (20mg)’
•Medical patient seen by Cardiology for PFO & atrial septal aneurysm with documentation of ‘no specific f/up’ next to PFO & atrial septal aneurysm.
•Medical patient with documentation of ATA occluded at fracture site on CTangio, Vascular aware will discuss at ORTH meeting. On 13/8 & 10/8 Vasc review of CTangio, ATA occludes, no further vascular intervention required.
•Patient reviewed by psych medical team for low blood pressure with Assessment/Plan 1. Given low fluid intake – encourage oral intake.
3.Also, in regards to care plans, does there need to be evidence that the advice received or care plan has been carried out?
VAHI Examples 21 and 22 only state that there is a plan documented/formulated.Does there need to be documentation of OT and PT reviewing and monitoring chest and mobility (as per example 21), and documentation of the frequent checks being carried out as per example 22?
In example 24, the formulation and documented plan is for the exercises to be completed at home (for DRAM). There would not be documentation of the patient completing these exercises. This is a common scenario in short stay cases.
Episode Identification
945521 Discharge Date 23.7.19 (increase oral intake)
Search Details
VAHI 11th Edition ICD-10-AM/ACHI/ACS Victorian Education
ACS 0002 - Errata 3
Firstly:
1.Is the VAHI 11th Edition ICD-10-AM/ACHI/ACS Victorian Education document still to be used by Victorian Coders as a supplement to ACS 0002, since the release of Errata 3 amendments to ACS 0002 (for implementation 1st January 2020)?
If so, we would like clarification in regards to this particular point regarding the Increased Clinical Care section and condition significance; where the VAHI document differs slightly to the ACS 0002 update.
Conditions are significant in an episode of care when clinical care provided for a condition is beyond routine (i.e. increased clinical care). Examples of increased clinical care include:
• providing care for a condition that is in excess of the routine care that would normally be provided by medical officer/nursing/allied health for that condition (e.g. documented evidence that the patient with dementia requires increased observation due to fluctuation in behaviour, cognition and physical condition)
• receiving clinical consultation for a condition with documentation of a clinical assessment, a diagnostic statement, or a care plan for the condition (e.g. patient referral to an oncologist for cancer assessment with documentation of advice received; wound specialist/nurse assessment of pressure injury with documentation of staging of pressure injury and care plan). Note that a care plan may include an adjustment to, or continuation of, the current treatment plan, or transfer to another facility with documentation of the reason(s) for transfer
• performance of a therapeutic intervention for a condition (e.g. dialysis for end-stage renal failure, pharmacotherapy for multiple sclerosis)
• pre and postoperative management in excess of routine care (see also ACS 1904 Procedural complications)
The sentence in the above point “receiving clinical consultation for a condition with documentation of assessment, a diagnostic statement OR a care plan for the condition”, implies a condition can be coded if it meets ANY of the criteria listed in the sentence (clinical assessment, a diagnosis, care plan).
However, the update to 0002 has been reworded, and though similar, the associated sentence here has been extrapolated out to dot-points that are followed by “AND”, implying that ALL three documentation points must be met (assessment + diagnosis+ care plan).
Conditions are significant in an episode of care when clinical care provided for a condition is beyond routine (i.e. increased clinical care). Examples of increased clinical care include:
•providing care for a condition that is in excess of the routine care that would normally be provided by medical officer/nursing/allied health for that condition (eg documented evidence that the patient with dementia requires increased observation due to fluctuation in behaviour, cognition and physical condition)
•receiving clinical consultation for a condition with documentation of:
o a clinical assessment, and
o a diagnosis, and,
o a care plan for the condition (eg patient referral to an oncologist for cancer assessment with documentation of advice received; wound specialist/nurse assessment of pressure injury with documentation of staging of pressure injury and care
2.Should we apply the AND logic in the ACS 0002? Or for example, where there is consultation from another specialty or discipline, is this alone enough to meet criteria for Increased Clinical Care (assessment only)?
Examples:
•Methadone dependent patient seen by APS with documentation of ‘usually on meth 25mg daily go back to normal meth dose in a few weeks (20mg)’
•Medical patient seen by Cardiology for PFO & atrial septal aneurysm with documentation of ‘no specific f/up’ next to PFO & atrial septal aneurysm.
•Medical patient with documentation of ATA occluded at fracture site on CTangio, Vascular aware will discuss at ORTH meeting. On 13/8 & 10/8 Vasc review of CTangio, ATA occludes, no further vascular intervention required.
•Patient reviewed by psych medical team for low blood pressure with Assessment/Plan 1. Given low fluid intake – encourage oral intake.
3.Also, in regards to care plans, does there need to be evidence that the advice received or care plan has been carried out?
VAHI Examples 21 and 22 only state that there is a plan documented/formulated.Does there need to be documentation of OT and PT reviewing and monitoring chest and mobility (as per example 21), and documentation of the frequent checks being carried out as per example 22?
In example 24, the formulation and documented plan is for the exercises to be completed at home (for DRAM). There would not be documentation of the patient completing these exercises. This is a common scenario in short stay cases.
Episode Identification
945521 Discharge Date 23.7.19 (increase oral intake)
Search Details
VAHI 11th Edition ICD-10-AM/ACHI/ACS Victorian Education
ACS 0002 - Errata 3
Response
Question 1 – VICC advises the Eleventh Edition ICD-10-AM/ACHI/ACS Victorian education document, effective 1 January 2020 has been updated to align with the amendments to ACS 0002 Additional diagnoses.
Question 2 – In order to meet ACS 0002 Additional diagnoses, Increased clinical care, a condition must receive a clinical consultation with documentation of all three of the following requirements: a clinical assessment and a diagnosis and an associated care plan, for the condition.
Question 3 – VICC acknowledges ACS 0002 Additional diagnoses is silent on scenarios where the documented care plan for a condition is not carried out. A query addressing this gap in the standard has been submitted to IHPA. In the interim, Victorian coders are advised to continue to follow the advice provided in the updated Eleventh Edition ICD-10-AM/ACHI/ACS Victorian education document, which instructs coders to assign a code for the condition, if the condition has received a clinical consultation with documentation of a clinical assessment and a diagnosis with an associated care plan, regardless if the care plan was carried out. Future amendments will be made to the advice in the Eleventh Edition ICD-10-AM/ACHI/ACS Victorian education document when IHPA advice becomes available.
Question 2 – In order to meet ACS 0002 Additional diagnoses, Increased clinical care, a condition must receive a clinical consultation with documentation of all three of the following requirements: a clinical assessment and a diagnosis and an associated care plan, for the condition.
Question 3 – VICC acknowledges ACS 0002 Additional diagnoses is silent on scenarios where the documented care plan for a condition is not carried out. A query addressing this gap in the standard has been submitted to IHPA. In the interim, Victorian coders are advised to continue to follow the advice provided in the updated Eleventh Edition ICD-10-AM/ACHI/ACS Victorian education document, which instructs coders to assign a code for the condition, if the condition has received a clinical consultation with documentation of a clinical assessment and a diagnosis with an associated care plan, regardless if the care plan was carried out. Future amendments will be made to the advice in the Eleventh Edition ICD-10-AM/ACHI/ACS Victorian education document when IHPA advice becomes available.
