Coding Rules Current as at 18-Oct-2016 08: 31

Published 15 June 2015,
for implementation 01 July 2015.

Ref No: Q2861 | Published On: 15-Jun-2015 | Status: Current

SUBJECT: Same-day endoscopy for chronic incurable diseases

Q: 

What is the appropriate principal diagnosis for same-day endoscopic examination for chronic incurable conditions such as coeliac disease?

A:

Coeliac disease is a permanent intolerance to gluten proteins, present in wheat, rye, and barley. It is an autoimmune disorder, characterised by a chronic inflammatory state of the small intestinal mucosa and submucosa, which can impair digestion and absorption of nutrients, leading to malnutrition. Coeliac disease is diagnosed by small bowel biopsy in conjunction with specific blood tests. The only treatment is a strict lifetime gluten-free diet, which in a significant number of patients manages the disease, by allowing the small intestine mucosa to heal. A small percentage of patients will have refractory or treatment resistant coeliac disease.

Chronic incurable diseases, such as coeliac disease, Crohn’s disease or ulcerative colitis, that require ongoing treatment such as lifelong dietary restrictions or ongoing medication to manage the disease may be admitted for endoscopic surveillance or follow up. While the follow up examination may appear normal it does not mean the disease has been eradicated or cured.

ACS 2113 Follow up examinations for specific disorders provides guidance for the assignment of codes in categories Z08 and Z09 for conditions which may be cured or eradicated after treatment such as bladder cancer and gastric ulcer:

“Codes from category Z08 Follow-up examination after treatment for malignant neoplasms or Z09 Follow-up examination after treatment for conditions other than malignant neoplasms should be assigned as the principal diagnosis when a patient is admitted for follow-up of a condition and no residual condition or recurrences are found.

…

The appropriate code describing the type of previous treatment from category Z08 or Z09 should be assigned as the principal diagnosis.”

Chronic conditions such as coeliac disease, Crohn’s disease and ulcerative colitis cannot be eradicated or cured and with treatment/management ongoing, assignment of codes from these categories is inappropriate.

Therefore for chronic incurable conditions such as these, assign a code for the disease following the principles of ACS 0001 Principal diagnosis.

In the scenario cited the correct code to assign as principal diagnosis is K90.0 Coeliac disease.