Combined ICD10 codes: Difference between revisions

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To code some diagnoses as part of [[ICD10 collection]], several lines of entries in the [[Patient ~~viewer tab~~ ICD10]] need to be grouped together.

To code some diagnoses as part of [[ICD10 collection]], several lines of entries in the [[Patient Viewer Tab ICD10]] need to be grouped together.

To group diagnoses together, use the same [[Dx Priority]] for all of them.

Combined coding does not apply to [[CCI Collection]] (there is no priority), and there is nothing in the data that links a CCI code to the Dx it is related to.

~~{{ListICD10Category | categoryName = Iatrogenic}}~~

== Coding instructions ==

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*In general, when you have a manifestation and a cause, the two codes should be combined.

** For example, in Septic Shock that has led to liver failure, the two should be coded with the same priority.

=== Situations in which linking is completely reasonable: ===

*link bugs with an infection,

*link trauma with its mechanism,

*link codes to “create” an entity for which no separate ICD10 code exists, such as retroperitoneal hemorrhage,

*to connect cause with effect(s), e.g. a trauma combined with all the separate fractured bones.

=== Q&A: Just How Far Should You Go in Linking Cause and Effect Diagnoses? ===

*If it is abundantly clear that A caused B that caused C and all of A, B, and C are all Admit or all Acquired, then combine them together. '''If it is possible but not COMPLETELY clear that the items are causally linked, then do NOT combine them'''

*Example#1: Stabbed --> lots of internal organ injuries from the stabbing --> big blood loss ---> hemorrhagic shock --> cardiac arrest.

*Example #2: Chemotherapy --> N/V as an adverse effect --> dehydration --> orthostatic syncope. But Chemo also caused drug-induced thrombocyotopenia as an adverse effect. And Chemo also caused Skin rash as an adverse effect. And all were present on admission (or all occurred after admission and so are Acquired diagnoses). In this case we have the Chemo causing problems in 3 separate pathways. Here again, we want you to combine all 6 codes together with the same priority number.

Rash

/\

|

Adverse effect of chemo ---> N/V --> dehydration --> syncope

|

\/

Drug-induced thrombocytopenia

*What about when there's a diagnosis (A) which is a known risk factor for another diagnosis (B). But in fact B is influenced by other things, not only A. In this case, do NOT combine A and B.

**Example: Diabetes is a risk factor for MI. But so are hypertension, hyperlipidemia and genetic factors. So here do NOT combine the MI with the diabetes (or the hypertension or hyperlipidemia) because it's not a direct arrow from diabetes to MI. But of course, do code all of these diagnoses that are present (in the example that means code the diabetes and the MI, and hypertension if present, etc).

Thanks for clarifying the diabetes issue. [[User:DPageNewton|DPageNewton]] 12:21, 2019 October 10 (CDT)

=== Primary Admit Diagnosis in Combined Codes ===

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** '''[[Retroperitoneal area, diagnostic imaging, abnormal]]'''

* [[Hospital-acquired pneumonia (HAP) in ICD10]]

~~== Questions and concerns ==~~

~~{{discussion}}{{ICD10| needs review}}~~

*When coding septic shock, should we put in the organ damage issues connected to the septic shock code with the same priority number? ie. liver problems, renal problems, thrombocytopenia, etc. related to the shock? If we don't do this we don't really have a shock liver code so with the current list there is nothing to show this link. Just need to clarify this. It is tricky because there can be multiple causes of organ damage even in the same patient.--[[User:LKolesar|LKolesar]] 13:26, 2018 February 8 (CST)

** Yes you should. See [[Combined ICD10 codes]]. Mind you it was kind of hidden, so I used your example to emphasize. However, I guess sometimes one of the codes will be an admit and the other an acquired. Not sure how we will deal with that one. Still needs to be addressed. Ttenbergen 22:03, 2018 March 20 (CDT)

== Some specific cases ==

{{ICD10 Guideline Signs Symptoms Test Results not needed when cause known}}

=== Other co-codes ===

*In addition to the combined coding situations listed above, you can combine codes when it makes sense to you to do so. The general guideline should be that codes be combined (instead of just both listed in the diagnosis list) when they are '''strongly''' related to each other.

*Use your judgement. Either listing them separately, or combined ensures that they're all there.

== CCMDB Data Integrity Checks ==

Some codes always need to be combined with one or more others.

Most infection codes require combined-coding of a pathogen (some have it implied, like [[Mumps]]), and some disorders can have a pathogen if their cause is infectious. See [[Bug required]] for details.

== Transition notes ==

Yes, this different from how we used to use dx priorities where they had to be unique.

== Data ==

The records are combined by same [[L_ICD10 table|L_ICD10]].[[Dx Priority]].

== Related articles ==

[[Category: ICD10]]

[[Category: ICD10/CCI Conversion]]

@@ Line 1: / Line 1: @@
-To code some diagnoses as part of [[ICD10 collection]], several lines of entries in the [[Patient viewer tab ICD10]] need to be grouped together.
+To code some diagnoses as part of [[ICD10 collection]], several lines of entries in the [[Patient Viewer Tab ICD10]] need to be grouped together.
 To group diagnoses together, use the same [[Dx Priority]] for all of them.
+Combined coding does not apply to [[CCI Collection]] (there is no priority), and there is nothing in the data that links a CCI code to the Dx it is related to.
-{{ListICD10Category | categoryName = Iatrogenic}}
 == Coding instructions ==
@@ Line 19: / Line 18: @@
 *In general, when you have a manifestation and a cause, the two codes should be combined.
 ** For example, in Septic Shock that has led to liver failure, the two should be coded with the same priority.
+=== Situations in which linking is completely reasonable: ===
+*link bugs with an infection,
+*link trauma with its mechanism,
+*link codes to “create” an entity for which no separate ICD10 code exists, such as retroperitoneal hemorrhage,
+*to connect cause with effect(s), e.g. a trauma combined with all the separate fractured bones.
+=== Q&A: Just How Far Should You Go in Linking Cause and Effect Diagnoses? ===
+*If it is abundantly clear that A caused B that caused C and all of A, B, and C are all Admit or all Acquired, then combine them together.  '''If it is possible but not COMPLETELY clear that the items are causally linked, then do NOT combine them'''
+*Example#1:  Stabbed --> lots of internal organ injuries from the stabbing --> big blood loss ---> hemorrhagic shock --> cardiac arrest.
+*Example #2:  Chemotherapy --> N/V as an adverse effect --> dehydration --> orthostatic syncope.  But Chemo also caused drug-induced thrombocyotopenia as an adverse effect.  And Chemo also caused Skin rash as an adverse effect.  And all were present on admission (or all occurred after admission and so are Acquired diagnoses).  In this case we have the Chemo causing problems in 3 separate pathways. Here again, we want you to combine all 6 codes together with the same priority number.
+    Rash
+     /\
+     |
+     |
+    Adverse effect of chemo ---> N/V --> dehydration --> syncope
+     |
+     |
+     \/
+    Drug-induced thrombocytopenia
+*What about when there's a diagnosis (A) which is a known risk factor for another diagnosis (B).  But in fact B is influenced by other things, not only A.  In this case, do NOT combine A and B.
+**Example:  Diabetes is a risk factor for MI.  But so are hypertension, hyperlipidemia and genetic factors.  So here do NOT combine the MI with the diabetes (or the hypertension or hyperlipidemia) because it's not a direct arrow from diabetes to MI.  But of course, do code all of these diagnoses that are present (in the example that means code the diabetes and the MI, and hypertension if present, etc).
+Thanks for clarifying the diabetes issue. [[User:DPageNewton|DPageNewton]] 12:21, 2019 October 10 (CDT)
 === Primary Admit Diagnosis in Combined Codes  ===
@@ Line 31: / Line 54: @@
 ** '''[[Retroperitoneal area, diagnostic imaging, abnormal]]'''
 * [[Hospital-acquired pneumonia (HAP) in ICD10]]
-== Questions and concerns ==
-{{discussion}}{{ICD10| needs review}}
-*When coding septic shock, should we put in the organ damage issues connected to the septic shock code with the same priority number?  ie. liver problems, renal problems, thrombocytopenia, etc. related to the shock?   If we don't do this we don't really have a shock liver code so with the current list there is nothing to show this link.   Just need to clarify this. It is tricky because there can be multiple causes of organ damage even in the same patient.--[[User:LKolesar|LKolesar]] 13:26, 2018 February 8 (CST)
-** Yes you should. See [[Combined ICD10 codes]]. Mind you it was kind of hidden, so I used your example to emphasize. However, I guess sometimes one of the codes will be an admit and the other an acquired. Not sure how we will deal with that one. Still needs to be addressed. Ttenbergen 22:03, 2018 March 20 (CDT)
 == Some specific cases ==
 {{ICD10 Guideline Combined dx metastasis primary}}
-{{Trauma w mechanism}}
+{{ICD10 Guideline Trauma w mechanism}}
-{{ICD10 infection}}
+{{ICD10 Guideline Infection}}
-{{ICD10 Guideline Combined dx AB resistancee}}
+{{ICD10 Guideline Combined dx AB resistance}}
-{{ICD10 Symptoms not needed when cause known}}
+{{ICD10 Guideline Signs Symptoms Test Results not needed when cause known}}
 === Other co-codes ===
 *In addition to the combined coding situations listed above, you can combine codes when it makes sense to you to do so.  The general guideline should be that codes be combined (instead of just both listed in the diagnosis list) when they are '''strongly''' related to each other.
 *Use your judgement.  Either listing them separately, or combined ensures that they're all there.
+== CCMDB Data Integrity Checks ==
+Some codes always need to be combined with one or more others.
+Most infection codes require combined-coding of a pathogen (some have it implied, like [[Mumps]]), and some disorders can have a pathogen if their cause is infectious. See [[Bug required]] for details.
 == Transition notes ==
 Yes, this different from how we used to use dx priorities where they had to be unique.
 == Data ==
 The records are combined by same [[L_ICD10 table|L_ICD10]].[[Dx Priority]].
+== Related articles ==
+{{Related Articles}}
 [[Category: ICD10]]
 [[Category: ICD10/CCI Conversion]]