# On a Lighter Note

On a Lighter Note ... 

ICD Coding Newsletter 

August 1999 

Hospital Distribution List 

?Health Information Manager/s (HIMS) 

?Clinical Coders 

?Information Technology (IT) 

?Interested Others 

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The ICD Coding Newsletter supports the clinical coding function performed 

in Victoria by Health Information Managers and Clinical Coders, by 

providing relevant information for these professionals and their associates. 

The newsletter, prepared by the Victorian ICD Coding Committee in conjunction 

with the Department of Human Services, seeks to: 

?ensure the standardisation of coding practice across the state ?provide a forum for resolution of coding queries ?address topical coding education issues, and 

?inform on national and state coding issues from the Victorian perspective. 

The scope of the newsletter includes answers to selected coding queries, coding 

feature articles, and feedback on the quality of coded data (as reported to the 

Victorian Admitted Episodes Dataset). 

Should you have any queries or comments regarding the ICD Coding Newsletter, 

contact: 

Wendy Dickins, Sara Harrison or Shannon Watts. 

HDSS Help Desk: 

Telephone 9616 8141 

Fax 9616 7629 

Email PRS2.Help-Desk@dhs.vic.gov.au 

Website www.dhs.vic.gov.au/ahs/hdss 

The following proformas are provided for your use: 

?Victorian ICD Coding Committee Query Form 

(Refer to page 19 of the May 1999 edition of this newsletter for guidelines on query 

submission, including alternative means of lodging a query.) ?Changes to Mailing Details. 

Editors’ Note

In July 1999, the first issue of the Health Data Standards and Systems Bulletin was 

distributed to Victorian hospitals and industry bodies. Two further issues have been 

released since then. 

This Bulletin is produced on an ad hoc basis, by HDSS, and provides: 

?answers to common questions recently directed to the HDSS Help Desk 

?directives for implementation of revisions to data collection specifications 

(VAED, VEMD, ESIS), including notification of amendments to specified data 

collection reference tables 

?feedback on selected data quality studies undertaken, and 

?information on upcoming events. 

With the introduction of this Bulletin, the ‘Information Updates’ section of the ICD 

Coding Newsletter will cease to include material that is covered by the scope of the Bulletin. Updates relating to coding audits and selected data quality activities, 

involving coded data, will continued to be published in this newsletter. 

The Bulletins are presently being loaded onto the HDSS website at: 

www.dhs.vic.gov.au/ahs/hdss 

Wendy Dickins & Sara Harrison 

Abbreviations 

DHS Department of Human Services 

ESIS Elective Surgery Information System 

HDSS Health Data Standards and Systems 

thICD-10-AM Statistical Classification of Diseases and Related Health Problems, 10

Revision, Australian Modification MDC Major Diagnostic Category 

PRS/2 Patient Reporting System 2 

VAED Victorian Admitted Episodes Dataset (name of the admitted patient data 

collection from 1 July 1999) VEMD Victorian Emergency Minimum Dataset 

Contents 

Coding Features 1 

Diabetes With Multiple Complications 1 Intraperitoneal Chemotherapy 7 

Preparation For Dialysis 11 

thVictorian Coding Committee’s 20 birthday 12 

Information Updates 14 

Data Quality 14 

Audit of 1998-1999 VIMD Data 14 

Audit of 1999-2000 VIMD Data 15 1999 Calendar of Events 16 

On a Lighter Note 17 

ICD Coding Committee 18 

ICD Coding Committee Members as at 1 August 1999 18 ICD Coding Committee Calendar of Meetings 18 

Coding Features 

Diabetes With Multiple Complications 

Compiled by Andrea Groom and Linda Cornell 

This Coding Feature seeks to clarify the use of code: 

E1x.7x Diabetes mellitus with multiple complications, 

following advice provided in June 1999 Coding Matters (page 14). The advice in Coding Matters is effective for separations from 1 July 1999. 

Multiple complications of diabetes is coded to E1x.7x. This code is used instead of 

multiple individual E1x.xx codes (thereby overruling the dagger/asterisk 

convention). As E1x.7x does not provide detail of the specific complications, the 

‘asterisk’ code for each complication is added. It is not necessary to assign specific 

diabetes code(s) (E1x.xx) before each complication (asterisk) code. 

E1x.7x Diabetes mellitus, with multiple complications may be assigned as the principal diagnosis or as an associated diagnosis code, depending on the reason for 

admission. 

If the diabetic complication is the reason for admission, or receives specific treatment 

during the admission, these complications should be ‘coded out’, that is assign specific diabetes codes rather than .7 Withmultiple complications. Any other diabetic complications may be ‘bundled’ together using .7 Withmultiple complications. 

Note that the edits regarding the use of multiple asterisk codes without their 

corresponding dagger codes have been removed from the VAED. 

Example 1 

Patient admitted for treatment of a specific diabetic complication, for example 

diabetic nephropathy. The patient also has other diabetic complications of 

retinopathy and neuropathy. Following ACS 0001 to assign the principal diagnosis 

(the reason for admission), the following codes are assigned: 

E1x.2x?Diabetes mellitus, with renal complicationsN08.3* Glomerular disorders in diabetes mellitus

E1x.7x Diabetes mellitus, with multiple complicationsMay Be Reproduced ICD Coding Newsletter - August 1999 1

H36.0* Diabetic retinopathy

G63.2* Diabetic polyneuropathy

Example 2 

If the same patient had ESRF as a complication of the diabetic nephropathy, and was 

admitted for treatment of the ESRF (not admitted for preparation for dialysis), the 

following codes would be assigned: 

N18.0 End-stage renal disease

E1x.7x Diabetes mellitus, with multiple complicationsN08.3* Glomerular disorders in diabetes mellitusH36.0* Diabetic retinopathy

G63.2* Diabetic polyneuropathy

Refer to the Coding Feature Preparation for Dialysis, page 11. 

Example 3 

Patient admitted for unstable diabetes. Has diabetic complications of nephropathy, 

retinopathy and neuropathy. In this case, as no single diabetic complication is the 

threason for admission, E1x.7x may be assigned as principal diagnosis, with a 5

character of ‘1’ to indicate the unstable diabetes.

E1x.71 Diabetes mellitus, with multiple complications, stated as uncontrolled

N08.3* Glomerular disorders in diabetes mellitusH36.0* Diabetic retinopathy

G63.2* Diabetic polyneuropathy

Example 4 

Patient admitted with uncontrolled diabetes, presenting as ketoacidosis. Patient also 

has diabetic retinopathy. The following codes would be assigned: 

E1x.11 Diabetes mellitus, with ketoacidosis, stated as uncontrolled

E1x.3x?Diabetes mellitus, with ophthalmic complicationsH36.0* Diabetic retinopathy

2ICD Coding Newsletter - August 1999 May be reproduced 

Following ACS 0001 the reason for admission is uncontrolled diabetic ketoacidosis. 

This is therefore sequenced as principal diagnosis. As there is only one other 

diabetic complication, .7 With multiple complications is not assigned, rather the 

specific diabetes with ophthalmic complications and diabetic retinopathy codes. 

May Be Reproduced ICD Coding Newsletter - August 1999 3

Example 5 

Patient admitted with diabetic hypoglycaemia (as had skipped a few meals). The 

patient also required treatment for his infected (pseudomonas) diabetic foot ulcers. 

He also has diabetic neuropathy. The following codes would be assigned: 

E1x.5x Diabetes mellitus, with peripheral circulatory complicationsL97 Ulcer of lower limb, NEC

B96.5 Pseudomonas as the cause of diseases classified to other chaptersE16.2 Hypoglycaemia, unspecified

E1x.4x Diabetes mellitus, with neurological complicationsG63.2* Diabetic polyneuropathy

Hypoglycaemia (E16.x) is assigned as an additional code to the diabetes code 

(Coding Matters, January 1999). 

Example 6 

Same patient as in example 5, but in addition has diabetic nephropathy. The 

following codes would be assigned: 

E1x.5x Diabetes mellitus, with peripheral circulatory complicationsL97 Ulcer of lower limb, NEC

B96.5 Pseudomonas as the cause of diseases classified to other chaptersE16.2 Hypoglycaemia, unspecified

E1x.7x Diabetes mellitus, with multiple complicationsN08.3* Glomerular disorders in diabetes mellitusG63.2* Diabetic polyneuropathy

Example 7 

Patient admitted for treatment of diabetic foot so documented (has leg ulcer and 

neuropathy). The following codes would be assigned: 

E1x.7x Diabetes mellitus, with multiple complicationsL97 Ulcer of lower limb, NEC

G63.2* Diabetic polyneuropathy

This illustrates another instance where .7 With multiple complications can be the principal diagnosis code. ACS 0401 Diabetes Mellitus, Diabetic foot (page 72) gives 

further detail regarding the coding of Diabetic Foot. 

4ICD Coding Newsletter - August 1999 May be reproduced