EmailPlan for post-discharge management
Publication Date: May 2023
Implementation Date: 1/06/2023
ICD 10 AM Edition: Twelfth Edition
Query Number: 3869
VICC #3646 advises that a condition (hypokalaemia) meets ACS 0002 Additional diagnoses as there is a clinical assessment, diagnosis and care plan, where the care plan is provision of a discharge prescription (slow K) and for GP to repeat U&Es.
Can the Committee please clarify whether this condition would still have met ACS 0002 if no discharge prescription had been provided, i.e. the plan was only for the repeat U&Es with the GP?
If a patient receives clinical consultation for a condition with a diagnosis, assessment and care plan documented where the plan is only for specific post-discharge management (e.g. repeat bloods, imaging, or a surgical procedure), is this sufficient to meet ACS 0002 Additional diagnoses point three; Increased clinical care, or should ACS 0002 Incidental findings and conditions be applied?
Can the Committee please clarify whether this condition would still have met ACS 0002 if no discharge prescription had been provided, i.e. the plan was only for the repeat U&Es with the GP?
If a patient receives clinical consultation for a condition with a diagnosis, assessment and care plan documented where the plan is only for specific post-discharge management (e.g. repeat bloods, imaging, or a surgical procedure), is this sufficient to meet ACS 0002 Additional diagnoses point three; Increased clinical care, or should ACS 0002 Incidental findings and conditions be applied?
Response
VICC notes this query was received under Eleventh Edition coding but resolved in Twelfth Edition.
VICC advises for the scenario in VICC #3646 ACS 0002 Additional diagnoses and discharge medication that the hypokalaemia would not have met ACS 0002 Additional diagnoses in Eleventh Edition if the plan was only for repeat U&Es post discharge by the GP.
In Eleventh Edition if the medications were not prescribed, hypokalaemia would not have met ACS 0002 section titled Increased clinical care dot point ‘receiving clinical consultation’ as it was the prescription of medications which constituted the ‘clinical assessment’ and care plan.
In Twelfth Edition conditions for which only a referral for follow up or management post discharge are made do not meet criteria for coding as per the following sections of ACS 0002:
- ACS 0002 section titled Additional diagnosis criteria/Increased clinical care: ‘Assign an additional diagnosis code where a condition requires increased clinical care (ie care that is beyond routine) and is not already precluded by the 'do not assign' instructions under the Commencement, alteration or adjustment of therapeutic treatment criterion.’
- ACS 0002 section titled Commencement, alteration or adjustment of therapeutic treatment: ‘Do not assign an additional diagnosis code for a condition that is referred for follow up care after discharge only (see Example 17)’.
Therefore the plan for post discharge U&E alone is insufficient for the hypokalaemia to meet ACS 0002 as the management is outside the episode of care.
For Twelfth Edition, VICC considers for the scenario cited in VICC #3646 ACS 0002 Additional diagnoses and discharge medication, the hypokalaemia, if verified, would meet ACS 0002 Additional diagnoses criteria commencement, alteration or adjustment of therapeutic treatment as medication was prescribed during the episode of care for treatment of the hypokalaemia.
VICC #3646 ACS 0002 Additional diagnoses and discharge medication has been retired.
VICC advises for the scenario in VICC #3646 ACS 0002 Additional diagnoses and discharge medication that the hypokalaemia would not have met ACS 0002 Additional diagnoses in Eleventh Edition if the plan was only for repeat U&Es post discharge by the GP.
In Eleventh Edition if the medications were not prescribed, hypokalaemia would not have met ACS 0002 section titled Increased clinical care dot point ‘receiving clinical consultation’ as it was the prescription of medications which constituted the ‘clinical assessment’ and care plan.
In Twelfth Edition conditions for which only a referral for follow up or management post discharge are made do not meet criteria for coding as per the following sections of ACS 0002:
- ACS 0002 section titled Additional diagnosis criteria/Increased clinical care: ‘Assign an additional diagnosis code where a condition requires increased clinical care (ie care that is beyond routine) and is not already precluded by the 'do not assign' instructions under the Commencement, alteration or adjustment of therapeutic treatment criterion.’
- ACS 0002 section titled Commencement, alteration or adjustment of therapeutic treatment: ‘Do not assign an additional diagnosis code for a condition that is referred for follow up care after discharge only (see Example 17)’.
Therefore the plan for post discharge U&E alone is insufficient for the hypokalaemia to meet ACS 0002 as the management is outside the episode of care.
For Twelfth Edition, VICC considers for the scenario cited in VICC #3646 ACS 0002 Additional diagnoses and discharge medication, the hypokalaemia, if verified, would meet ACS 0002 Additional diagnoses criteria commencement, alteration or adjustment of therapeutic treatment as medication was prescribed during the episode of care for treatment of the hypokalaemia.
VICC #3646 ACS 0002 Additional diagnoses and discharge medication has been retired.
