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

Published 15 June 2015,
for implementation 01 July 2015.

Ref No: Q2952 | Published On: 15-Jun-2015 | Status: Current

SUBJECT: High output ileostomy

NOTE: this may be a change in coding practice

Q:

Is high output ileostomy classified as a procedural complication?

A: 

High output ileostomy (HOS) refers to excessive effluent (> 2000ml per day) from an ileostomy, resulting in fluid, sodium and magnesium depletion, with malnutrition as an extreme late complication.  HOS is a likely outcome when there is less than 200cm of residual small intestine and no colon. Other causes include: intra-abdominal sepsis, partial bowel obstruction, (infectious) enteritis and recurrence of disease in the remaining intestine (eg Crohn’s disease). HOS management includes treatment of the underlying cause, replacement of water and electrolyte imbalances, anti-diarrhoeal medications and nutritional support.

HOS is considered a procedural complication as per the definition in ACS 1904 Procedural complications:

A condition or injury which is directly related to a surgical/procedural intervention.

Therefore, follow the guidelines in ACS 1904 and assign:

K91.4 Colostomy and enterostomy malfunction

with additional code(s) for any manifestation(s) (eg dehydration, electrolyte imbalance)

followed by:

Y83.3 Surgical operation with formation of external stoma

Y92.22 (Place of occurrence) Health service area

References:

Baker, M., Williams, R., and Nightingale, J. (2009). Causes and management of high-output stoma. Doi: 10.1111/j.1463-1318.2009.02107.x