Acute Paraplegia and Management - Excel

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					                        AR-DRG Version 5 Recommendation Summary
                    NB Guide to this document                       file note re outstanding submissions.doc
                                                                    ..\..\Ardrg5\Version 5.0 CCCA Recommendations.xls

       Shading indicates disagreement among groups consulted or proposals that have
       not been subjected to clinical review

                                                                                 Supported by
                                                                        CCCG          C'wlth     (preliminary)

       Rec ID       Recommendation                                  Y(es) N(o) M(ixed) R(evised) W(ithheld) Comment (*)


       PR.A10.01    Pre-MDC DRGs for pain management devices              M              R             N         major

       MDC 01
       01.B76.01    Paediatric age split in Seizure DRG                   Y              Y             Y

       MDC 04
       04.901.01    Amyloidosis with lung involvement                     M             W              W         minor

       MDC 05
       05.F09.01    Ventricular assist devices                            N              N             N         minor
                                                                                                                 Either (depends
       05.F19.01    New DRG for radio frequency ablations                 Y             N              N         on X04 data)
       05.F42.01    New DRG for electrophysiology study                   Y             W              W         minor

       MDC 06
       06.G07.01    Other procedures on appendix                          W             W              W         Major
       06.G12.02    Angioplasty for mesenteric atherosclerosis            R             R              R         Minor

       MDC 09
       09.J10.01    Revision of burn scar                                 R              R             R         Major
       09.J60.01    New DRG for hyperbaric oxygenation                                   Y             Y         Major

       MDC 10
       10.K01.02    Debridement procedures for diabetic foot              R              R                       Minor
       10.K09.01    Vascular bypass surgery for diabetes comp             W              N                       Major

       MDC 14
                  Urgency of admission will appear in the
                  2000-01 national morbidity data for the first
                  time. Analysis of the resource implications
                                                                     The possibility of partitioning Caesarean
                  of emergency admission caesarean delivery         Delivery adjacent DRG with respect to
                  will be undertaken when the data is               urgency of admission will be examined for
       MDC review available.                                        the next major release.                      Minor
       14.O40.01    DRG for laparoscopic sterilisation procedures          Y               N             N       Minor

                    Major' denotes that resolution of this
                    recommendation is likely to require a major
       * 'Comment': revision.

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Version 5.2         Description Of Problem                                    Requested By     Decision
Recommendation ID
Across MDCs
00.AST              Grouper should read the asterisk code as the PDX even Mr William Pyper,    Recommend CSAC and NCCH to
                    it is not sequenced as the PDX in a dagger and asterisk Department of      change the Australian Coding Standards
                    combination. Eg, read D63.0 Anaemia in neoplastic       Health, WA         for dagger and asterisk codes that they
                    disease as PDX in both cases PDX=C50.9 Breast,                             can be coded in any order
                    unspecified, SDX=D63.0 and PDX=C16.9 Stomach,
                    unspecified, SDX=D63.0.

00.BIOP             Remove biopsy codes from surgical eye DRGs as biopsy Ms Janet            Review in Version 6
                    should not put long-stay ophthalmic cases into surgical Stretton, Sydney
                    DRGs.                                                   Hospital Complex

00.BRON             Review procedure status of bronchoscopy codes -           Ms Jennie       • Move 41892-01, 43912-00 from E01 to
                    mixture of ORs, NonORs, PROCs                             Shepheard,      E02 • Review procedure status of
                                                                              Department of   bronchoscopy codes in Version 6
                                                                              Human Services,

00.NAME             901Z, 902Z, 903Z are valid DRGs but fall under the     Ms Andrea           Renumber of 901Z, 902Z, 903Z to 801Z,
                    heading of Error DRGs giving the impression that they  Groom, Southern     802Z, 803Z in Version 6. The new DRGs
                    are invalid. Many misunderstand what they are. Suggest Health              would be grouped together as ‘Unrelated
                    renaming these DRGs under the heading of Edit DRGs                         ORs’.
                    (or similar).

00.TRAN             35321-00 Transcatheter embolisation of blood vessel       Casemix          Refer to CSAC to consider expanding
                    was added to 8 more MDCs in V5.1. The procedure is        Technical        the generic code 35321-00 to specific
                    now very common to different MDCs. Review whether         Development      sites
                    the generic code should be more site specific.            Section

CC.01               Remove CC status of Z93.0 Tracheostomy status as      Ms Andrea       No change
                    status code merely indicates that a patient has a     Groom, Southern
                    tracheostomy whereas care code (Z43.0) indicates some Health
                    care or attention to the trache has been performed.

CC.02               Remove CC status of Z99.1 Dependence on respirator,       Ms Catherine     • Retain Z99.1 as a CC • Remove Z99.2
                    Z99.2 Dependence on renal dialysis (in line with coding   Perry, NCCH      as a CC

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CC.03   G81.9 Hemiplegia, unspecified is a CC but G81.0            Ms Jennie       Change G81.0, G81.1 to CCs
        Flaccid hemiplegia and G81.1 Spastic hemiplegia are        Shepheard,
        not CCs. Review CC status.                                 Department of
                                                                   Human Services,
CC.04   Patient with PDX I50.0 Congestive heart failure (CCL=2),   Ms Jennie       Refer to CSAC to consider the options
        ADXs N17.9 Acute renal failure unspecified (CCL=3), I48    Shepheard,      given or other alternatives
        Atrial fibrillation and flutter (CCL=2), E11.51 Type 2     Department of
        diabetes mellitus with peripheral angiopathy without       Human Services,
        gangrene (CCL=2) groups to DRG F62A Heart failure          Vic
        and shock W Catastrophic CC (PCCL=4). When E11.29
        Type 2 diabetes mellitus with other specified renal
        complication (CCL=3) is included, E11.29 excludes
        N17.9, E11.51 and the patient groups to DRG F62B
        (W/O Catastrophic CC) with PCCL=3. Review CCL
        values and CC exclusion list.

CC.05   Recognise K35.0 Acute appendicitis with generalised        Ms Andrea       No change
        peritonitis as a more complicated condition than K35.9     Groom, Southern
        Acute appendicitis, unspecified.                           Health

CC.06   New X04 codes, review severity level of decubitus ulcer    Casemix          Review CC status of L89.x when cost
        L89.0 (stage 1), L89.1 (stage 2), L89.2 (stage 3), L89.3   Technical        data of L89.x becomes available
        (stage 4) and L89.9 (unspecified)                          Development

CC.07   Ectopic pregnancy O03 should point to a surgical column    Casemix          Point O03 to the same matrix column as
        on the CCL matrix. We need to investigate how this         Technical        O02, O04, O05 (column 51)
        came about (was it like this in the Yale matrix), and      Development
        whether this is causing allocation of lower CCL value,     Section
        and, if so, is this valid.

CC.08   T89.0x Complications of open wounds should be CCs.        Ms Andrea       Change T89.02 to a CC
        T79.3 Post-traumatic wound infection NEC is a CC.         Groom, Southern
        T89.0x are complications specific to open wounds. Now Health
        that bug codes are not CCs. These codes are the only
        way to recognise infections as significant complications.

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CC.09       Remove CC status of Z63.2 Inadequate family support,     Ms Andrea         • Remove CC status of Z63.2, Z71.3 •
            Z71.3 Dietary counselling and surveillance. What made    Groom, Southern Review CCs in mental health DRGs in
            Z63.2 different to other Z63 codes (Other problems       Health. Ms Jennie Version 6
            related to primary support group, including family       Shepheard,
            circumstances) to be a CC? Z71.3 can be used for         Department of
            documentation of dietary discussion but this does not    Human Services,
            appear to be worth a CC?                                 Vic

14.CC.01    Review CCs in obstetrics to ensure that all applicable   Ms Andrea       CC changes (as given in 14.CC.01)
            codes are CCs, eg O25 Malnutrition in pregnancy is not   Groom, Southern
            a CC but E46 Malnutrition NOS is.                        Health

PR.A06.01   Codes 90179-03, 90179-04, 90179-05, 90179-06, 92035- Ms Andrea            No change until CSAC fixes ventilation
            01 (management of artificial airways) and the addition of Groom, Southern codes
            these codes moves some cases into intubation or           Health
            ventilation ADRGs (A06, A41). These cases should not
            be grouped to A06 or A41. Eg a patient admitted with
            abdominal pain has a tracheostomy (90179-06) which
            requires toilette for a day and the DRG is A06Z.

PR.A06.02   Remove 30294-01 Laryngopharyngectomy and plastic         Casemix          No change until CSAC fixes ventilation
            reconstruction from DRG A06Z Tracheostomy or             Technical        codes
            ventilation > 95 hours. The 2nd ed code included         Development
            formation of a tracheostomy but from the 3rd ed          Section
            onwards, the code does not include tracheostomy.
            Tracheostomy is required to code separately.

PR.A41.01   Move 90179-06 Management of tracheostomy to ADRG Ms Jennie                No change until CSAC fixes ventilation
            A41 Intubation age<16 to be with all management of        Shepheard,      codes
            intubation codes                                          Department of
                                                                      Human Services,
PR.961.04   Remove R45.81 Suicidal ideation from unacceptable         Ms Jennie       Move R45.81 from 961 to Z64
            PDX list as this code is often the only one available for Shepheard,
            patients admitted to psychiatric facilities.              Department of
                                                                      Human Services,
MDC 01

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01.B02.02   Remove 40803-00 Intracranial stereotactic localisation    Ms Andrea       • Remove 40803-00 from B02 • Remove
            from ADRG B02 Craniotomy to in line with coding           Groom, Southern 90011-05 from B03 • Move 40803-00,
            standards.                                                Health          90011-05 to B06, B07

01.B02.04   Intracranial hypertelorism corrections are expansive  Ass Prof Bruce       • Add 45767-00, 45767-01, 45770-00 to
            procedures but they are placed in some low cost DRGs. Johnstone, The       B02 • Move 45767-00, 45767-01, 45770-
            Review placement of these procedures.                 Royal Children's     00 from I17 to I15

01.B04.01   Review procedures in ADRG B04 Extracranial vascular       Ms Linda Best,   Remove procedures (listed in 01.B04.01)
            procedures. Codes misplaced in B04 eg 45045-00            NCCH
            Excision of AVM of eyelid.

01.B07.01   Review procedure status. 39118-00 Percutaneous            Ms Jennie       • No change to 39118-00, 39118-01 •
            neurotomy for facet joint denervation by radiofrequency   Shepheard,      Change 39323-00, 39323-01 to PROCs
            is not an OR but 39323-00 Other percutaneous              Department of
            neurotomy by radiofrequency is.                           Human Services,

01.B60.02   Acute paraplegia/quadriplegia was formerly grouped to Mr William Pyper,    • Reject grouping acute
            DRG 29 Spinal Disorders and Injuries in Version 2.1 and Department of      paraplegia/quadriplegia to B61 • Create
            DRG 20 Acute Quadriplegia/Paraplegia W or W/O OR        Health, WA         one ADRG for acute and one ADRG for
            Procedure in Version 3.0. In Version 5.1, they                             chronic and unspecified in Version 6
            correspond to ADRGs B61 Spinal Cord Conditions W or
            W/O OR Procedures and B60 Established
            Paraplegia/Quadriplegia W or W/O OR Procedures. The
            reasons for removing it from B61 might be pertinent in
            any future discussion of its correct placement.

01.B63.01   Request moving F10.7 Alcoholic dementia from ADRG         Ms Joanne        No change. The error was corrected in
            V60 Alcohol intoxication and withdrawal to DRG B63Z       Chicco, NSW      Version 5.1.
            Dementia and other chronic disturbances of cerebral       Health

01.B67.02   Review placement of E75.x Disorders of sphingolipid       Casemix          Move E75.3, E75.5, E75.6 from K63 to
            metabolism and other lipid storage disorders. They are in Technical        B67
            MDCs 01 and 10.                                           Development

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01.B67.03   Remove G31.1 Senile degeneration of brain, not                Ms Kerry Innes,   Move G31.1 from 961 to B67
            elsewhere classified from unacceptable PDX list and           NCCH
            make it a PDX in ADRG B67 Degenerative nervous
            system disorders.

01.901.01   Review G90.0 Idiopathic peripheral autonomic                  Ms Vivienne       • Add pacemaker function to B06, B07 •
            neuropathy with pacemaker procedures 38281-10,                Rodgers, St       Group pacemaker to B06A, B07A in
            38284-00 grouped to 901Z.                                     Andrew's War      Version 6
                                                                          Hospital. Ms Sara
                                                                          Department of
                                                                          Human Services,
01.901.02   Review combination of diabetes with impotence (E1x.43) Mr William Pyper, Refer to CSAC to resolve conflict
            and surgical procedures grouped to 901Z.               Department of     between ACS 0001, ACS 0401
                                                                   Health, WA

01.901.03   Review T85.0 Mechanical complication of ventricular           Ms Evana          No change. The error was corrected in
            intracranial shunt with 90330-00 Revision of                  Sinclair, The     Version 5.0.
            cerebrospinal fluid shunt at peritoneal site grouped to       Townsville
            901Z.                                                         Hospital
01.901.04   Review S02.8 Fractures of other skull and facial bones        Ms Evana          Add 90530-03 to B06, B07
            with 90530-03 Open reduction of fracture of facial bone,      Sinclair, The
            NEC grouped to 901Z.                                          Townsville
01.901.05   45590-00 Reconstruction of orbital cavity is not listed as    Ms Jennie         • Move S02.9 from I76 to B79 • Add
            an OR for MDC 01. As this procedure can be performed          Shepheard,        45590-00, 45590-01, 45593-00, 45593-
            for fractured orbit coded to S02.8 Fractures of other skull   Department of     01, 45593-02, 45593-03, 42533-00,
            and facial bones, an MDC 01 code. This procedure              Human Services,   30052-01, 90530-03 to B06, B07
            should be listed for MDC 01.                                  Vic

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01.901.06   I65.2 Occlusion and stenosis of carotid artery with 35309- Ms Susan Turner, No change. The error was corrected in
            06 Percutaneous transluminal balloon angioplasty with      John Flynn Gold Version 5.1.
            stenting, single stent groups to 901Z                      Coast Private
                                                                       Hospital. Ms
                                                                       Rodgers, St
                                                                       Andrew's War
                                                                       Hospital. Ms Katie
MDC 02
02.901.01   Review C44.1 Malignant neoplasms of skin of eyelid,       Ms Joanne        Add 31000-00 to C14
            including canthus with 31000-00 Microscopically           Chicco, NSW
            controlled serial excision of lesion of skin grouped to   Health
MDC 03
03.901.01   Review K10.2 Inflammatory conditions of jaws with        Ms Evana          Add 30023-01 to D12
            30023-01 Excisional debridement of soft tissue involving Sinclair, The
            bone or cartilage grouped to 901Z.                       Townsville
03.901.02   Review H70 codes (mastoiditis and related conditions)     Ms Jennie       Add 41584-00, 41584-01 to D02
            with 41584-01 Partial resection of temporal bone with     Shepheard,
            mastoidectomy and decompression of facial nerve or        Department of
            41584-00 Partial resection of temporal bone with          Human Services,
            mastoidectomy grouped to 901Z.                            Vic

03.901.03   Add 30223-03 Incision and drainage of abscess of soft     Casemix          Add 30223-03 to D12
            tissue to MDC 03. Cases with this code group to 901Z.     Technical
03.902.01   Add 30052-01 Repair of wound of eyelid to MDC 03.         Casemix          Add 30052-01 to D12
            Cases with this code group to 902Z.                       Technical
MDC 04
04.E01.01   Review procedure status. 38415-00 Incision of pleura is   Casemix          • Change 38415-00 from PROC to OR •
            not an OR but 38418-04 Incision of lung is an OR.         Technical        Add 38415-00 to E02, W04, X06

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04.901.02   Review S22.2 Fracture of sternum with 47467-00 Open        Ms Jennie       Add 47467-00 to E02
            reduction of fracture of sternum grouped to 901Z.          Shepheard,
                                                                       Department of
                                                                       Human Services,
MDC 05
05.F02.01   Move 38524-02 Adjustment of automatic defibrillator        Ms Andrea       Move 38524-02 from F01 to F02
            generator from ADRG F01 Implantation or replacement        Groom, Southern
            of AICD, total system to DRG F02Z AICD Compontent          Health

05.F03.01   Procedures in blocks 687 and 688 are composite codes       Casemix           Move 38565-01, 38553-02, 38553-03,
            of sites - aorta, aortic valve and coronary arteries.      Technical         38556-02, 38556-03, 38562-02, 38562-
            Review which part of the code should drive for grouping.   Development       03, 38565-02, 38565-03 from F07, F09,
            If valve drives for grouping, they should group to ADRGs   Section           F14 to F03, F04
            F03 and F04.

05.F06.01   Patient has I71.2 Thoracic aortic aneurysm, without        Ms Joanne         No change
            mention of rupture, 38562-03 Replacement of aortic arch    Chicco, NSW
            and ascending thoracic aorta with aortic valve             Coding Advisory
            replacement, 38603-00 Cardiopulmonary bypass,              Committee
            peripheral cannulation, 38500-00 Coronary artery
            bypass, using 1 LIMA graft, 38497-01 Coronary artery
            bypass, using 2 saphenous vein grafts. 38500-00 or
            38497-01 assigns the patient to ADRG F06 Coronary
            bypass W/O invasive cardiac investigation but the
            hospital believes 38562-03 should be used for grouping.
            When 38562-03 coded with 38603-00, it groups to
            ADRG F07 Other cardiothoracic/vascular procedures W
            CPB pump. Review grouping of this patient.

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05.F12.01   Review logic for pacemaker DRGs F12Z, F17Z, F18Z.       Ms Andrea       • Any pacemaker insertion combined
            For a pacemaker replacement, sometimes only one lead Groom, Southern    with one or more electrode insertions is
            is replaced or inserted because there is already one    Health          treated as a pacemaker implantation •
            functioning lead in-situ. However, when an insertion of                 Change 38281-00 from OR to NonOR •
            one lead is coded in combination with a dual chamber                    Change 38278-00, 38278-01, 38284-00,
            pacemaker insertion, the DRG F17Z is given rather than                  90214-00 from NonORs to ORs • Review
            DRG F12Z.                                                               ADRG names for F12, F17, F18 in
                                                                                    Version 6

05.F19.01   38700-03 Closure of cardiac collateral vessel, 38739-00   Casemix       Move 38700-03, 38739-00 from F19 to
            Atrial septectomy or septostomy are in DRG F19Z Other     Technical     F07, F09
            trans-vascular percutaneous cardiac intervention. F19Z    Development
            already has the percutaneous version of 38700-03 and      Section
            38739-00. The more extensive procedures 38700-03 and
            38739-00 should not be in this DRG.

05.F20.01   Review grouping. Patient with I72.0 Aneurysm of carotid Ms Joanne       No change
            artery, 39821-00 Extracranial to intracranial bypass with Chicco, NSW
            saphenous vein graft, 32760-00 Procurement of vein        Health
            from limb for bypass or replacement graft, 39015-00
            Insertion of external ventricular drain groups to DRG
            F20Z Vein ligation and stripping. Grouper does not seem
            to like a carotid artery diagnosis with an intracranial
            procedure. Depending on the site of the carotid, it may
            be either pre-cerebral or cerebral but the grouper does
            not agree.

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05.901.01   Review I86.4 Gastric varices with 30606-01 Oversewing Ms Joanne             • Remove I86.0, I86.4 from F65 •
            of gastric varices grouped to 901Z.                   Chicco, NSW           Remove I85.0, I85.9, I98.20, I98.21 from
                                                                  Coding Advisory       MDC 06 • Move I86.0 to D66 • Move
                                                                  Committee             I85.0, I85.9, I86.4, I98.20, I98.21 to H63 •
                                                                                        Add 90301-00 to H06 • Remove principal
                                                                                        diagnosis test in H40 • Change
                                                                                        additional diagnosis test to diagnosis test
                                                                                        in H40

05.901.02   Review I70.1 Atherosclerosis of renal artery with 35309- Ms Michelle        No change. The error was corrected in
            07 Percutaneous transluminal balloon angioplasty with    Enright, Pindara   Version 5.0.
            stenting, multiple stents grouped to 901Z                Private Hospital

05.903.01   Review I78.0 Hereditary haemorrhagic telangiectasia      Ms Jennie       No change
            with 36839-01 Endoscopic destruction of lesion of        Shepheard,
            prostate grouped to 903Z.                                Department of
                                                                     Human Services,
MDC 06
06.G02.01   Review placement of 14212-00 Fluid reduction of          Ms Rhonda          No change. The error was corrected in
            intussusception in ADRG G02 Major small and large        Pfeiffer,          Version 5.0.
            bowel procedures. The procedure is a very minor          Department of
            sameday procedure but results in this major ADRG.        Human Services
06.G03.01   Add 30554-01 Oesophagectomy with reconstruction by       Casemix            Add 30554-01, 90954-00 to G03
            other free flap and 90954-00 Other reconstruction of     Technical
            oesophagus to ADRG G03 Stomach, oesophageal and          Development
            duodenal procedures.                                     Section

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06.G04.01   Review grouping. Patient with K40.90 Unilateral or         Ms Joanne      No change
            unspecified inguinal hernia, without obstruction or        Chicco, NSW
            gangrene, not specified as recurrent, 30609-02             Health
            Laparoscopic repair of inguinal hernia, unilateral, 30393-
            00 Laparoscopic division of abdominal adhesions stayed
            one day in hospital. The uncomplicated day stay patient
            admitted for laparoscopic repair of inguinal hernia. Some
            adhesions were divided during the procedure. This
            record groups to ADRG G04 Peritoneal adhesiolysis
            which has a higher cost weight and expected LOS than
            DRG G09Z Inguinal and femoral hernia procedures age
            > 0.

06.G12.01   35726-01 Staging laparotomy appears in ICD-10-AM         Ms Andrea       • Remove 35726-01 from edit table D.8b
            Chapter X Procedures on digestive system. Remove         Groom, Southern • Add 35726-01 to M01
            35726-01 from edit table D.8b female procedures.         Health

MDC 07
07.H01.01   30458-01 Incision of sphincter of oddi is less complex   Casemix          Move 30458-01 from H01 to H02
            than remaining cases in ADRG H01 Pancreas, liver and     Technical
            shunt procedures which are more complicated              Development
            pancreas/liver procedures. Review placement of 30458-    Section
            01 in H01.

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07.H40.01   1) DRG H40Z Endoscopic procedures for bleeding           Ms Andrea      Refer to 05.901.01 and 07.H63.01
            oesophageal varices requires a principal diagnosis from Groom, Southern
            TAB-H40-1, an additional diagnosis from TAB-H40-2 and Health
            a procedure from TAB-H40-3. This will pick up the
            dagger and asterisk combinations, ie diagnosis codes in
            blocks K70, K71 and K74 with I98.21 Oesophageal
            varices in diseases classified elsewhere, with bleeding.
            However, for other causes of bleeding varices, the code
            I85.0 Oesophageal varices with bleeding will be
            sequenced as a principal diagnosis with the cause as an
            additional code, therefore they will not group to DRG
            H40Z. For example, oesophageal varices with bleeding
            due to portal hypertension, admitted for treatment of
            varices, will be coded to I85.0 with K76.6 Portal
            hypertension as an additional diagnosis. 2) DRG H40Z
            will also not pick up schistosomiasis (B65 codes) with
            bleeding oesophageal varices, which is a dagger and
            asterisk combination but B65 codes are not included in

07.H40.02   Review logic of DRG H40Z Endoscopic procedures for        Casemix       • Retain additional diagnosis test in H40
            bleeding oesophageal varices. Consider removing test      Technical     but superseded by 05.901.01 • Remove
            for secondary diagnosis of bleeding oesophageal varices   Development   30476-00, 30476-01 from H40 • Add
            in the definition (I85.0, I98.21).                        Section       30478-11, 30478-12 to H40 • Refer to
                                                                                    CSAC to review procedures in H40
                                                                                    whether some of them can be removed
                                                                                    from ICD-10-AM

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07.H63.01   Move B65.2 Schistosomiasis due to Schistosoma                  Casemix         Move B65.2, B65.8, B65.9 from T64 to
            japonicum from ADRG T64 Other infectious and parasitic         Technical       H63
            diseases to ADRG H63 Disorders of liver except malig,          Development
            cirrhosis, alcoholic hepatitis. Schistosoma japonicum and      Section
            Schistosoma mansoni are liver parasites. B65.1
            Schistosomiasis due to Schistosoma mansoni is in H63
            but B65.2 is in T64.

07.901.01   1) Review K86.3 Pseudocyst of pancreas with 30224-             Ms Evana        • Remove 30394-00, 90319-00 from H05
            01Percutaneous drainage of intra-abdominal abscess,            Sinclair, The   • Add 30224-01, 30224-02, 30394-00,
            haematoma or cyst grouped to 901Z. 2) Review K75.0             Townsville      90319-00 to H06
            Abscess of liver with 30224-01 grouped to 901Z.                Hospital. Ms
                                                                           Joanne Chicco,
                                                                           NSW Coding
                                                                           Committee. Ms
                                                                           Shepheard, DHS,
                                                                           Vic. Ms Sara
                                                                           Department of
                                                                           Human Services,
MDC 08
08.I12.01   Review inclusion of M09.0x (x=0-9) Juvenile arthritis in       Casemix         Add M09.0x, M09.1x, M09.2x to I12
            psoriasis (L40.5†), M09.1x (x=0-9) Juvenile arthritis in       Technical
            Crohn’s disease [regional enteritis] (K50.-†) and M09.2x       Development
            (x=0-9) Juvenile arthritis in ulcerative colitis (K51.-†) in   Section
            ADRG I12 Infect/inflam of bone & joint W misc musc
            system & connective tissue procs.

08.I17.01   Review placement of procedures from Block 1710                 Casemix         Move procedures in Block 1710 from I17
            Frontal bone advancement in DRG I17Z Maxillo-facial            Technical       to I15
            surgery.                                                       Development

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08.I23.01   Patient has S72.3 Fracture of shaft of femur, 47921-00        Ms Joanne          Review principal diagnosis test in
            Insertion of internal fixation device, NEC and subsequent     Chicco, NSW        surgical ADRGs in Version 6
            procedure 47927-00 Removal of pin, screw or wire, NEC         Coding Advisory
            prior to separation. 47927-00 overrides 47921-00 and          Committee
            assigns the patient to DRG I23Z Local excision and
            removal of internal fixation device excl hip and femur.
            Should 47921-00 be used for grouping and group to
            ADRG I28 Other connective tissue procedures?

08.I23.02   Patient has C41.2 Malignant neoplasm of vertebral             Ms Joanne          • No change to the grouping • Review
            column, 50227-01 En bloc resection of lesion of bone          Chicco, NSW        I23, I28 in Version 6
            with anatomic specific autograft, 47726-00 Procurement        Coding Advisory
            of bone for graft via separate incision, 47921-00 Insertion   Committee
            of internal fixation device, NEC and groups to DRG I23Z
            Local excision and removal of internal fixation device
            excl hip and femur. I23Z seems to be an anomalous
            DRG given the extent of the surgery performed. Review
            grouping of this patient.

08.I23.03   Review C47.3 Malignant neoplasm of peripheral nerves          Ms Elizabeth       Review placement of C47 codes in
            of thorax with 38647-00 Division of thoracic adhesions,       Lawson,            Version 6
            38446-02 Removal of lesion of mediastinum via                 Melbourne
            thoracotomy grouped to DRG I23Z Local excision and            Private Hospital
            removal of internal fixation device excl hip and femur.

08.I30.01   46486-00 Primary repair of nail or nail bed and 46489-00      Casemix            • Remove 46486-00, 46489-00 from TAB-
            (secondary repair) in TAB-I30-2, TAB-I30-3, TAB-X05-2,        Technical          I30-2, TAB-X05-2 • Review debridement
            TAB-X05-3, delete both procedures from TAB-I30-2,             Development        of nail bed in I30, X05 in Version 6
            TAB-X05-2.                                                    Section

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08.I30.03   1) Review hand diagnosis codes in DRG I30Z Hand                Casemix               • Remove C47.1, C49.1, D21.1, M66.30,
            procedures. Any hand codes missing? Any non-hand               Technical             M92.7 from I02, I20, I30 • Move 90590-
            codes included? 2) Review procedures in TAB-I30-3.             Development           00 from I30 to I27 • Move 46510-00 from
            Procedures misplaced in I30Z eg 45451-14 Full                  Section               I20 to I30 (TAB-I30-2) • Remove 90673-
            thickness skin graft to burn, neck.                                                  00 from I20 • Review procedures in TAB-
                                                                                                 I30-3 in Version 6

08.I69.01   M80 codes are all composite codes of osteoporosis              Mr Ian Titular,       • Review placement of M48.4x, M48.5x,
            combined with pathological fracture and group to ADRG          Australian            M49.5x, M80.xx, M84.3x in Version 6 •
            I69 Bone disease and specific arthropathies. Should            Institute of Health   Review whether split I65 or change
            M80.x5 (pelvic region and thigh) be in ADRG I77                and Welfare.          name of I65 in Version 6
            Fractures of pelvis and the rest of M80 in ADRG I65            Casemix
            Connective tissue malignancy including pathological            Technical
            fracture?                                                      Development

08.I75.01   Scapula fracture codes group to ADRGs I76 Other           Ms Kate Chen, St Move S42.11, S42.19 from I76 to I75
            musculoskeletal disorders, I75 Injury to shoulder, arm,   George Hospital
            elbow, knee, leg or ankle. Suggest to move S42.11
            Fracture of body of scapula, S42.19 Multiple fractures of
            scapula to I75.

08.I75.03   Review placement of clavicle codes S42.0x (x=0-3, 9) in        Casemix               Move S42.0x (x=0-3, 9) from I75 to I76
            ADRG I75 Injury to shoulder, arm, elbow, knee, leg or          Technical
            ankle. Shoulder refers to the joint but clavicle is not part   Development
            of the joint.                                                  Section

08.I76.01   Review placement of principal diagnosis M25.76                 Casemix               Move M25.76 from I75 to I76
            Osteophyte lower leg in ADRG I75 Injury to shoulder,           Technical
            arm, elbow, knee, leg or ankle                                 Development
MDC 09

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09.J12.01   1) Review diagnoses and procedures in ADRG J12            Ms Andrea              • Remove codes (listed in 09.J12.01) in
            Lower limb procedures W ulcer/cellulitis. Codes           Groom, Southern        J12 • Change principal diagnosis test to
            misplaced in J12 eg L03.01 Cellulitis of finger, 30052-01 Health                 diagnosis test in J12 • Remove L03.02,
            Repair of wound of eyelid. 2) Review principal diagnoses                         L03.11, L89.x, L97, Q82.0 in J13
            and procedures in ADRG J13 Lower limb procedures
            W/O ulcer/cellulitis. J13 uses the same principal
            diagnosis and procedure tables of J12.

09.901.01   Review M79.46 Hypertrophy of fat pad, lower leg with           Ms Joanne         Add 49558-00 to J11, J12, J13
            49558-00 Arthroscopic debridement of knee grouped to           Chicco, NSW
            901Z.                                                          Coding Advisory
09.901.02   Review D17.7 Benign lipomatous neoplasm of other               Ms Vivienne    Add 35713-14 to J11
            sites with 35713-14 Excision of lesion of pelvic cavity        Rodgers, St
            grouped to 901Z.                                               Andrew's War
                                                                           Hospital. Ms
                                                                           Shepheard, DHS
09.901.03   Review L60.0 Ingrowing nail with 48400-05 Ostectomy of Mr Elvis Maio, Add 48400-05 to J11, J12, J13
            toe grouped to 901Z.                                   NSW Department
                                                                   of Health

09.902.01   1) Review L90.51 Scar conditions and fibrosis of skin          Casemix          • Move L90.51 from J67 to Y62 • Add
            due to burn and 45519-00 Revision of burn                      Technical        procedures (listed in 09.902.01) to Y01,
            scar/contracture grouped to 902Z. 2) NCCH agreed to            Development      Y03
            review the addition of a fifth digit to diagnosis code L90.5   Section. Ms
            (for burn) in ICD-10-AM and Commonwealth agreed to             Andrea Groom,
            review grouping of the 5-digit code.                           Southern Health.
                                                                           Ms Annette
                                                                           Gilchrist, Royal

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09.902.02   Review L91.01 Keloid scar due to burn and 45519-00         Ms Katie McLeod, • Move L91.01 from J67 to Y62 • Add
            Revision of burn scar/contracture grouped to 902Z.         The Townsville   45025-00, 45200-00, 45439-00, 45506-
            Could this group to DRG J10Z Skin, subcutaneous            Hospital         00, 45506-01, 45515-00, 45518-00 to
            tissue and breast plastic OR procedures?                                    Y01, Y03

MDC 10
10.K01.01   All episodes in DRG K01Z Diabetic foot procedures          Mr William Pyper, Rename K01 in Version 6
            should have a diagnosis code of diabetic foot. It is       Department of
            possible to get into K01Z without a diabetic foot problem. Health, WA

10.K01.02   Review procedures in DRG K01Z Diabetic foot                Mr William Pyper, Remove 35759-00, 45448-09, 52626-00
            procedures. Procedures misplaced in this DRG, eg           Department of     from K01
            45448-09 Small split skin graft of other areas of face.    Health, WA.

10.K06.01   Move 14203-01 Direct living tissue implantation from       Ms Jennie       Move 14203-01 from K06 to K09
            DRG K06Z Thyroid procedures to DRG K09Z Other              Shepheard,
            endocrine, nutritional and metabolic OR procedures.        Department of
                                                                       Human Services,
10.K09.01   Cases with diabetes (E1x.73, E1x.63) and bypass            Casemix          Review K01 by Endocrinology CCCG,
            surgery (vascular) group to DRG K09Z Other endocrine,      Technical        Cardiovascular CCCG
            nutritional and metabolic OR procedures. However, if       Development
            diabetes is not present in the above scenario, the cases   Section
            group to ADRG F08 Major reconstruction vascular
            procedures W/O CPB pump. The above diagnosis codes
            have multiple components. It is recommended that
            grouping be determined by mapping the component that
            is related to the procedure performed.

10.901.01   Review E10.73 Type 1 diabetes mellitus with foot ulcer     Ms Evana         Add 30223-03 to K01
            due to multiple causes with 30223-03 Incision and          Sinclair, The
            drainage of abscess of soft tissue grouped to 901Z.        Townsville

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10.901.02   Review E11.69 Type 2 diabetes mellitus with other          Ms Jillian        No change. The error was corrected in
            specified complication (or E11.73 Type 2 diabetes          Burgoyne, Alice Version 5.1.
            mellitus with foot ulcer due to multiple causes) with      Springs Hospital.
            30023-01 Excisional debridement of soft tissue involving   Ms Karen Cecil,
            bone or cartilage grouped to 901Z.                         The Northern

10.901.03   Review E11.73 Type 2 diabetes mellitus with foot ulcer     Ms Jill Burgoyne, No change
            due to multiple causes with 30017-01 Excisional            Alice Springs
            debridement of burn, < 10% of body surface area            Hospital
            excised or debrided (or 30020-00 Excisional
            debridement of burn, >= 10% of body surface area
            excised or debrided) grouped to 901Z.

MDC 11
11.L06.01   Review stress incontinence whether it is a reproductive    Casemix           • No change to placement of stress
            problem or a bladder problem or both. Male procedures      Technical         incontinence procedures • No change to
            also appear in ADRG M06 Other male reproductive            Development       placement of N39.3 • Refer to CSAC to
            system OR procedures and female procedures in DRG          Section           review whether a male code and a
            N06Z Female reproductive system reconstructive                               female code should be created to
            procedures.                                                                  replace N39.3

11.L06.02   Remove OR status of 36842-00 Endoscopic lavage of          Ms Jennie       • No change to 36842-00 • Change
            blood clots from bladder. This is a relatively minor       Shepheard,      36851-00 from OR to PROC
            procedure.                                                 Department of
                                                                       Human Services,
11.L42.01   Patient had 36833-01 Endoscopic removal of ureteric     Kim Sommerfeld, Change hierarchy to locate L42 above
            stent (or 36812-00 Cystoscopy), 36546-00 ESWL of        Mater Hospital  L41
            urinary tract and stayed 1 day in hospital. The case
            groups to DRG L41Z Cystourethroscopy, sameday, not
            DRG L42Z ESWL for urinary stones. 36833-01 (or 36812-
            00) is a minor procedure. The hierarchy is out of order
            and L42Z should locate above L41Z.

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11.L62.01   Patient with C67.9 Malignant neoplasm of bladder,           Ms Jennie       • Change 37330-01, 37330-00 from
            unspecified and 37330-01 Complete urethrectomy              Shepheard,      PROC to OR • Add 37330-01 to L06 •
            grouped to ADRG L62 Kidney and urinary tract                Department of   Add 37330-00 to L08
            neoplasms because the procedure is a PROC but it            Human Services,
            appears to be a significant OR. Review the status of the    Vic

11.L63.01   Review placement of N13 codes (obstructive and reflux       Casemix          Move N13.5, N13.8 from L63 to L67
            uropathy). Placement of N13.8 is questioned whether it      Technical
            includes or excludes infection.                             Development
11.901.01   1) Review N32.1 Vesicointestinal fistula with 32024-00      Ms Jennie       Review placement of N32.1 in Version 6
            High restorative anterior resection of rectum with          Shepheard,
            intraperitoneal anastomosis grouped to 901Z. When the       Department of
            code for closure of vesicointestinal fistula is added, it   Human Services,
            overrides the digestive system code. However, when a        Vic
            colectomy or stoma procedure is performed, the fistula is
            not necessarily closed. 2) Also review codes from
            procedure blocks 897, 913, 915, 933, 986.

11.901.02   Add 30224-01 Percutaneous drainage of intra-abdominal Casemix                Add 30224-01 to L09
            abscess, haematoma or cyst to MDC 11. Cases with this Technical
            code group to 901Z.                                   Development
11.902.01   Add 30075-01 Biopsy of soft tissue to MDC 11. Cases         Casemix          Add 30075-01 to L09
            with this code group to 902Z.                               Technical
MDC 12
12.901.01   Review N42.1 Congestion and haemorrhage of prostate Ms Sara Harrison, Add 36842-00 to M06
            and 36842-00 Endoscopic lavage of blood clots from  Department of
            bladder grouped to 901Z.                            Human Services,

MDC 13

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13.N01.01   35664-00 Radical abdominal hysterectomy with radical     Ms Andrea    No change
            excision of pelvic lymph nodes and 35670-00 Abdominal Groom, Southern
            hysterectomy with radical excision of pelvic lymph nodes Health
            both group to ADRGs N02 Uterine, adnexa procedure for
            ovarian or adnexal malignancy and N03 (Non-ovarian or
            adnexal malignancy). However 35551-00 Radical
            excision of pelvic lymph nodes via laparoscopy for
            gynaecological malignancy and 35551-01 Radical
            excision of pelvic lymph nodes for gynaecological
            malignancy and other radical excision of lymph node
            codes group to DRG N01Z Pelvic evisceration and
            radical vulvectomy. Should 35664-00 and 35670-00 be
            grouped to N01Z?

13.N07.01   Advanced laparoscopy procedures 35638-XX (XX=00,        Ms Carol           No change
            01, 04-10) normally involve more than 1 hour in theatre Strickland, QFG
            and several hours in the recovery. Patients undergone   Day Theatres
            these procedures group to DRG N07Z Other uterine and
            adnexa procedures for non-malignancy. The low paying
            DRG does not adequately compense hospital facility.
            Review grouping these procedures.

13.901.01   Add 30224-01 Percutaneous drainage of intra-abdominal Casemix              Add 30224-01 to N11
            abscess, haematoma or cyst to MDC 13. Cases with this Technical
            code group to 901Z.                                   Development
MDC 14
14.O01.02   Ensure that case requires an outcome of delivery code       Ms Andrea       No change
            (Z37.x) to group to a delivery DRG.                         Groom, Southern
14.O02.01   Review procedure status of 90480-01 Suture of current       Casemix        Change 90480-01 from OR to PROC
            obstetric laceration of rectum and/or sphincter ani         Technical
            without perineal involvement. It was rejected to be an OR   Development
            in V5.0 but accepted in V5.1.                               Section

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14.O60.01   O43.8 placental abnormalities and O69.2 Cord around     Ms Andrea       No change
            neck (without compression) these uncomplicated          Groom, Southern
            conditions group to O60B Vaginal delivery W/O           Health
            catastrophic or severe CC. They should group to O60C
            Vaginal delivery single uncomplicated W/O other
            condition. Also review what other uncomplicated
            conditions should group to O60C.

14.O61.01   Ensure that case requires Z39.0x Postpartum care and    Ms Andrea       • No change to grouping of postpartum
            examination immediately after delivery to group to a    Groom, Southern cases • Move labour and delivery codes
            postnatal DRG.                                          Health          from O66 to O04, O61 in Version 6

MDC 15
15.P65.02   Investigate the effect of 92038-00 CPAP for any duration Ms Andrea       • Remain CPAP as a major problem •
            in ADRGs P65, P66, P67. CPAP in neonates is assigned Groom, Southern     Refer to CSAC to review the coding
            for any duration of CPAP but it acts as a major problem Health           guideline of CPAP or introduce hours to
            in the grouper for P65, P66, P67. Mechanical ventilation                 the code
            (MV) has to be for > 24 hours to have the same effect.
            CPAP is a lesser intervention than MV but 1 hour of
            CPAP will have the same effect as > 24 hours of MV.

15.P65.03   Review multiple major problem logic in ADRGs P65,       Casemix          Amend logic in P65A, P66A, P67A to
            P66, P67. Cases with 1 major problem and CPAP           Technical        Multiple major problems
            (92038-00) do not group to multiple major problems      Development
            DRGs but major problem DRGs.                            Section

15.MAJ.01   Add intracranial haemorrhages (P52.x, x=4, 6, 8-9) to   Ms Andrea       Add P52.4, P52.6, P52.8, P52.9 to major
            major problem list.                                     Groom, Southern problem list

MDC 18

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18.HIV.01   R16.2 Hepatomegaly with splenomegaly, not elsewhere         Casemix       Add R16.2 to S60, S65
            classified is in DRG H40Z Endoscopic procedures for         Technical
            bleeding oesophageal varices and ADRG H63 Disorders         Development
            of liver except malig, cirrhosis, alcoholic hepatitis. If   Section
            hepatomegaly and splenomegaly are coded separately,
            R16.0 Hepatomegaly, not elsewhere classified is in
            ADRGs H63, S60 HIV, sameday and S65 HIV-related
            diseases, and R16.1 Splenomegaly, not elsewhere
            classified is in ADRGs Q60 Reticuloendothelial and
            immunity disorders, S60, and S65. Why R16.2
            (hepatomegaly with splenomegaly) is not in S60 and
            S65? Review placement of R16.2.

MDC 19
19.U67.01   Review placement of R45.7 State of emotional shock        Mr William Pyper, Review placement of R45.x, R46.x in
            and stress, unspecified. R45.7 is in DRG U67Z             Department of     Version 6
            Personality disorders and acute reactions. An alternative Health, WA
            choice is to put R45.7 in ADRG Z64 Other factors
            influencing health status.

MDC 20
20.V60.01   Review v4.0 recommendation number 19.842.02 which           Casemix       No change
            was accepted on clinical grounds but held over to v5.0      Technical
            due to ICD-9 to ICD-10 mapping. It was decided to move      Development
            I-9 codes 291.5, 291.9, 292.11 and 292.12 from DRGs         Section
            860 and 861 in MDC 20 to DRG 842 in MDC 19.
            Equivalents in AR-DRG v4.1 are V60 and V61 (MDC 20)
            Alcohol intoxication and withdrawal, U62 (MDC 19)
            Paranoia and acute psychotic disorders.

MDC 21
21.W03.01   33836-0x (x=0-3) Repair of artery by anastomosis in both    Casemix       Remove 33836-0x (x=0-3) from W04
            DRG W03Z Abdominal procedures for multiple                  Technical
            significant trauma and DRG W04Z Other OR procedures         Development
            for multiple significant trauma. Determine which DRG        Section
            they should belong to.

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21.901.01   Review S65.1 Injury of radial artery at wrist and hand         Ms Susan Turner, Add 33818-02, 33818-03 to X05
            level with 33818-02 Repair of radial artery by direct          John Flynn Gold
            anastomosis grouped to 901Z.                                   Coast Private
21.901.02   An episode of T85.5 Mechanical complication of            Mr William Pyper, Add 14215-00 to X06
            gastrointestinal prosthetic devices, implants and grafts, Department of
            and 14215-00 Revision of gastric band groups to 901Z. If Health, WA
            the presenting complaint E86 Volume depletion is used
            as PDX, not the underlying cause T85.5, the episode
            groups to DRG K04Z Major procedures for obesity.
            Review grouping of this episode.

MDC 23
23.Z60.01   Review v4.0 Recommendation 0.000.06. Review PDXs Casemix                         Create SNAP classification in Version 6
            in ADRG Z60 Rehabilitation and use of CARE type (02.0- Technical
            02.3?).                                                Development
23.Z60.02   Move Z50.6 Orthoptic training from ADRG Z64 Other              Casemix           Move Z50.6 from Z64 to Z60
            factors influencing health status to ADRG Z60                  Technical
            Rehabilitation.                                                Development
23.Z64.03   NCCH advised that Z49.0 Preparatory care for dialysis          Ms Jennie         • Move Z49.0 from Z64 to L67 • Add
            should be used as PDX for patients to have a peritoneal        Shepheard,        34100-01, 34103-05, 34106-00, 34106-
            catheter inserted for renal dialysis, or for formation of an   Department of     01, 34106-04, 34106-05, 34106-09 to
            arteriovenous fistula for renal dialysis. However many         Human Services,   L09 • Refer to CSAC to endorse
            coders still assign N18.0 End stage renal disease as           Vic               classifying Z code that describes a
            PDX for these patients. Z49.0 is in MDC 23 and N18.0 in                          procedure not a diagnosis as an
            MDC 11. Thus the classification has two different DRGs                           unacceptable PDX • Recommend NCCH
            for grouping the same cases. Move Z49.0 to ADRG L67                              maintaining an unacceptable PDX list for
            Other kidney and urinary tract diagnoses.                                        updating DRG classification

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