CODES.AND.STUFF

Q.    Which code from ICD-10 category Z53.- Persons encountering health services for specific procedures, not carried out should be assigned when a patient is admitted for surgery and the procedure is cancelled because the patient has not stopped taking their Warfarin or the patient has eaten prior to surgery?

A.    A contraindication is any condition or factor that makes it inadvisable to employ a particular procedure or treatment. Therefore the failure to stop Warfarin or eating prior to surgery contraindicates surgery. ICD-10 codes from category Z53.- Persons encountering health services for specific procedures, not carried out, must only ever be assigned in a secondary field, with the condition prompting the admission sequenced in the primary field.

In the case of the two situations discussed below, the appropriate ICD-10 codes would be:

Example 1:

Patient admitted for an inguinal hernia repair and the procedure is cancelled because the patient has failed to stop taking their Warfarin:

K40.9 Unilateral or unspecified inguinal hernia, without obstruction or gangrene

Z53.0 Procedure not carried out because of contraindication

Z92.1 Personal history of long-term (current) use of anticoagulants

Example 2:

Patient admitted for an inguinal hernia repair and the procedure is cancelled because the patient has eaten prior to surgery:

K40.9 Unilateral or unspecified inguinal hernia, without obstruction or gangrene

Z53.0 Procedure not carried out because of contraindication

Note: Circumstances where a patient’s surgery is cancelled due to the lack of a bed or theatre time is not a contraindication and such situations should be coded using Z53.8 Procedure not carried out for other reasons.

Date published: 06/2009 (Volume 6 Issue 1)

Coding Clinic, NHS Classifications Service

www.connectingforhealth.nhs.uk/codingclinic

Tags: cancelled, contraindication, z codes