'Department of Health and Human services, Victoria, Australia'

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Code for urology review

Publication Date: September 2021

Implementation Date: 1/10/2021

ICD 10 AM Edition: Eleventh Edition

Query Number: 3752

The ACHI code 96037-00 [1824] Other assessment, consultation or evaluation includes:
Assessment NOS
Consultation NOS
Evaluation NOS
Interview NOS

The ACHI code 96090-00 [1869] Other counselling or education includes:
Counselling NOS
Education NOS

For example:

A urology nurse practitioner reviews the patient.
Sometimes, this nurse specialist could be working on behalf of an urologist and do the routine post procedural reviews. As most of these reviews are for day procedures, sometimes they have a documented care plan and sometimes they do not.

The other times they could be working as a specialist nurse referred for continence issues. These assessments usually result into documentation of a diagnosis with a proper care plan.

Could the VICC please clarify what would be the right code to assign in either of these scenarios?


VICC advises that as per ACS 0016 General procedure guidelines, many procedures may meet the definition of a clinical intervention but if they are routine in the treatment of the diagnosis being coded, it may not be necessary to code them.

A review by a clinician is expected or inherent in the diagnostic or therapeutic treatment plan of a patient and is not coded. However, this does not prevent a hospital from assigning a code for internal reporting purposes, but transmission of the code to the VAED must be suppressed.