1. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Linda Best 14.00 -14.45 Wednesday, 7th December 2011 ACS classification standards for ACHI

2. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА General standards for procedures  General procedure guidelines  ACS 0016 - Code all significant procedures that are carried out during the admission, therapeutic and diagnostic

3. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА General standards for procedures cont.  General procedure guidelines  ACS 0016 (cont) - A significant procedure is:  surgical in nature  carries a procedural risk  carries an anaesthetic risk  requires special facilities, equipment or specialised training

4. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА General standards for procedures cont.  Procedures normally not coded  ACS 0042 - List of procedures not normally coded:  Routine in nature  Drug treatment - Exception:  Specialty ACS instruction  Procedure performed under anaesthesia  Procedure is principle reason for admission

5. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Anaesthesia –  ACS 0031  Cerebral anaesthesia – block [1910] - General anaesthesia (GA) – intravenous, inhalational or both, assign if artificial airway is used - Sedation – if no use of artificial airway

6. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Anaesthesia –  ACS 0031 cont.  Conduction anaesthesia – block [1909] - Neuraxial block – epidural, spinal, caudal (or any combination) - Regional block – based on the general anatomical area of the field of anaesthesia - Infiltration of local anaesthesia – not coded

7. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Anaesthesia –  ACS 0031 cont.  Guidelines for coding anaesthesia - Hierarchy for assigning codes - Sequence the anaesthesia code following the procedure code(s) it relates to - Coding of Postprocedural analgesia

8. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020  Bilateral procedures - Definition Bilateral procedures are those which involve the same organ/structure on different sides of the body at the same operative episode

9. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020 cont.  Bilateral procedures (cont) - Classification guidelines  Inherently bilateral procedures e.g. tonsillectomy code once  Procedures with a bilateral code e.g. bilateral orchidectomy code once  Procedures with no code option for bilateral e.g. cataract extraction code twice home.hawaii.rr.com/dochazenfield/images/Norma http://www.matthews.co.nz/images/cataracts.jpg

10. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020 cont.  Multiple procedures - Definition ACHI generally refers to organs, diseases and sites using the singular tense. This is done for consistency and ease of updating. For example, the code title intranasal removal of polyp from maxillary antrum includes where one, or more than one, polyp is removed. Thus polyp can be interpreted as polyp or polyps. Other examples include wart(s), skin tag(s), biopsy/biopsies, lesion(s).

11. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020 cont.  Multiple procedures (cont) - Classification guidelines 1.The same procedure repeated during the episode of care at different visits to theatre – Code as many times as performed 2.The same procedure repeated during a visit to theatre involving one entry point/approach and similar/same lesions – Assign one code

12. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020 cont. 3.The same procedure repeated during a visit to theatre involving one entry point/approach and different lesions – e.g. suture a tendon and artery in the hand through a single incision requires two codes 4.The same procedure repeated during a visit to theatre involving more than one entry point/approach and more than one non-bilateral site – Assign a code for each procedure

13. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Bilateral/Multiple procedures  ACS 0020 cont. 5.Skin or subcutaneous lesion removal – Assign code for excision of multiple lesions e.g.:

14. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Laparoscopic/arthroscopic/endos copic surgery –  ACS 0023  ACHI has codes which differentiate between procedures using endoscopy via a traditional incision in some areas  If no endoscopic code available, use two codes; - one for the specific procedure - one for the endoscopy

15. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Procedure not completed or interrupted  ACS 0019  If a procedure is started but is then interrupted or not completed, code as far as it went: - if only an incision was made, code an incision of the site - if the surgeon entered a body cavity or space, code an exploration of the site

16. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Procedures distinguished on the basis of size, time or number of lesions or sites  ACS 0038  Some ACHI codes are distinguished on the basis of size, time or number of lesions removed  Where there is no documentation of this information, the index will usually list a default code

17. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Procedures distinguished on the basis of size, time or number of lesions or sites  ACS 0038 cont.  If there is no default code listed, assign a code for: - the smallest size - the least duration - the least number of lesions

18. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Allied health interventions –  ACS 0032  Rules for coding allied health interventions: - Assign a code from block [1916] to identify allied health interventions - Only one code per professional group for each admission

19. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Adhesions –  ACS 0047  Fibrous bands of scar tissue which stick to the surface of adjoining organs and pull them together  If division of adhesions performed, even if part of another procedure, code both the diagnosis of adhesions and the division of adhesions