Structure

ACHI stands for Australian Classification of Health Interventions. It is based on the Commonwealth Medicare Benefits Schedule (MBS) and was introduced
with ICD-10-AM in July 1998.

Like ICD-10-AM, ACHI is made up of two books:

→ the Tabular List

→ the Alphabetic Index.

Unlike ICD-10-AM, it only has numeric codes. The

codes have five digits with two-digit extensions.

ACHI contains codes for surgical operations, medical procedures and for other interventions such as allied healthcare interventions, dental services and
procedures performed outside the operating theatre.
Content within ACHI is organised along different axes.
Anatomical site axis
This is the primary axis. Within each chapter the anatomical site has been structured by a 'superior' to 'inferior' (head to toe) approach.
Procedure type axis
This is the secondary axis. It begins with the least invasive procedure, for example, examination, through to the most invasive procedure, for example,
reoperation.
Block axis
This is the tertiary axis. Blocks are numbered sequentially in the Tabular List to help users to locate a specific code. They have titles that relate specifically to
the codes contained within the block. Block numbers are shown as black reverse text boxes. Block numbers do not indicate valid codes and cannot be
assigned.
Exceptions
The following chapters in the Tabular List do not follow the general format:
→ dental services
→ obstetric procedures
→ radiation oncology procedures
→ non-invasive, cognitive and interventions, not elsewhere classified
→ imaging services
ͥ* As with ICD-10-AM, you should always look up procedures in the Alphabetic Index first
before you find the code in the Tabular List.

The Alphabetic Index

The Alphabetic Index is important because it contains many

more procedural terms than those appearing in the Tabular
List.
The terms are arranged alphabetically by lead term with sub-
terms underneath. Block numbers inside square brackets
will help you find the codes in the Tabular List.
 * You should never code directly from the Alphabetic Index or the Tabular List.
You must always cross reference one against the other. Look up the procedure or
intervention in the Alphabetic Index first (it contains many more terms than the Tabular
List), then confirm the code in the Tabular List.

Coding process
You are going to use the coding process again but this time you will be coding the principal intervention from Fahad's discharge summary.
* Make sure you have read the General Standards for Interventions in the ACS.
The process for coding interventions is the same as the process for coding diagnoses. The following is a simple guide intended to assist you in using the ACHI:
→ Identify the statement to be coded.
→ Locate the lead term, this is usually the name of an intervention.
→ Look up the lead term in the Alphabetic Index and make a note of the ACHI code and block number that apply.
→ Look for the block number in the Tabular List and locate the ACHI code that you identified in the Index. Remember to also review the notes under the
chapter and block headings.
→ Make a note of and apply any relevant standards from the ACS.

The first step is to identify the statement to be coded.

If you look at Fahad's discharge summary you can see that there are two interventions here.
You need to code the principal intervention.

Fahad's principal intervention is 'Right phacoemulsification and IOL (foldable, artificial) on 19-
01'. This is the statement you are going to code. Which is the lead term?

The lead term is Phacoemulsification. It is modified by the term 'and IOL (foldable, artificial)'.
'Right' just tells you which eye was operated on.

Using the Alphabetic Index

You have completed step 1 and 2 and identified 'phacoemulsification' as the lead term in Fahad's principal intervention. Now you must complete step 3 and
look it up in the Alphabetic Index.

The intervention 'Phacoemulsification' has 3 different codes against it. You can use the
terms after it to decide which is the right code in this case.

Which is the correct code for Fahad's intervention?

The correct code is 42702-04 [197].
It is not 42698-02 [197] because the physician specified that they inserted a lens (IOL).
It is not 42702-05 [197] because the physician specified that they inserted a foldable lens.

Make a note of the number inside the square brackets. This will tell you which block number to look up in
the Tabular List.
 It is important for you to understand the way entries in the Alphabetic Index are structured. Look at this entry and its component parts.

Using the Tabular List

Next you must complete step 4, verifying the code in the Tabular
List. First you need to find the block you need. At the end of the
code in the Alphabetic Index was the block number [197].

Always read the notes at the beginning of the block carefully. They
will help you find the right code.

Fahad had his cataract removed and then an artificial,

foldable lens was inserted. All three of these codes have
very similar descriptions beside them. You need to read
them carefully to make sure you have got the right one.
 Even though it doesn't apply in Fahad's case, you must remember
to look out for a downward-pointing triangle ▼.

This symbol indicates that there is an Australian Coding Standard

that should be checked. The standard number is shown under or
beside the symbol.

You must complete step 5, read and apply any relevant standard,
before assigning a code.

Conventions
Most codes use some additional conventions. It is important for you to recognise them and understand how to use them.

Review Fahad's discharge summary. He has an additional intervention recorded. He was

sedated during the lens replacement.

There is only one entry for 'Sedation'. The block number is [1910]. Look it up in the
Tabular List. Block 1910 is found in the chapter on anaesthesia and analgesia.
Look at Fahad's discharge note again. The additional intervention field has
the entry 'Intravenous sedation ASA 2'. This means that the person who
was sedated has a mild systemic disease, in this case, dementia. It is not
followed by the letter E so it was not an emergency.

As a coder, you assign the ASA and emergency modifier as documented by

the anaesthetist on the anaesthetic chart.
 What should you do next?
The downward pointing triangle means there is a standard here that you must read:
0031 ANAESTHESIA This standard explains different types of anaesthesia and will help you to assign the right code.

Assigning the code

After reading the General Standards for Interventions, you completed the process for coding Fahad's interventions because you:
→ Identified the statement to be coded.
→ Located the lead term.
→ Looked up the lead term in the Alphabetic Index and made a note of the block number that applies.
→ Looked up the block number in the Tabular List, read the notes under the chapter and block headings and matched the intervention to the codes listed.
→ Made a note of and applied any speciality standards from the ACS.

Finally, we need to assign a code to Fahad's principal

intervention. There were three possible codes under the
heading 197 Extracapsular crystalline lens extraction by
phacoemulsification.

What is the correct code for Fahad's principal intervention 'Phacoemulsification and IOL (foldable, artificial)'? Remember, intervention codes are numeric with
two-character extension codes separated by a hyphen from the main code.
42702-04 is the correct code because this is the one that mentions the artificial, foldable lens.

ACHI codes have five digits with a two-digit extension: 42702-04, but coders often include
the block number to make it easier to look up the intervention code in the Tabular List:
42702-04[197].
 Summary
→ Before you progress to the next section, review the key learning points.
→ ACHI consists of two books, the Tabular List and the Alphabetic Index.
→ ACHI codes are numeric only. They consist of 5 numbers with a two-digit extension.
→ ACHI is organised along three axes: anatomical site, intervention type and block number.
→ You must always read the Instructional Notes before assigning a code.
→ You must always look interventions up in the Alphabetic Index first. Locate the intervention code and block number. Remember, it is the block number which
you need to help locate the code in the Tabular List.
→ Interventions in the Tabular List consist of a Lead Term followed by a number of modifiers. Make sure the modifier matches your intervention.
→ There are conventions in ACHI that you must use correctly when you are coding.
→ You should use the same coding process as you used for ICD-10-AM.
→ You must apply the relevant Australian Coding Standards to your work.