Template:ICD10 Guideline Como vs Admit: Difference between revisions

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</noinclude>~~{{DiscussAllan | Integrated content from two pages into a template. Likely no questions, but could you check if this is what you actually had in mind for the below? }}~~

</noinclude>

=== When to use Comorbid vs Admit Diagnosis or neither ===

=== When to use [[Comorbid Diagnosis]] vs [[Admit Diagnosis]] or neither ===

==== When not to code a dx at all ====

* Dx was present in the past but is ~~not relevant to current admission~~

*Dx was present in the past but that problem is '''resolved''' AND does not fit into one of the [[:Category: Past medical history]] codes

** '''~~Example~~''': ~~patient~~ had ~~appendix removed 7 years ago and is now admitted with injuries from~~ a ~~car accident; don't~~ code the ~~appendix removal at all~~.

**To be clear on this -- do NOT code past problems that are fully resolved unless they are one of the [[:Category: Past medical history]] codes

* Do not code diagnoses that occur during this admission as a comorbid diagnoses. If they have completely resolved then do not code as a comorbid diagnosis until the next admission if applicable. ie. surgical ward had a COVID pneumonia resolved prior to ICU admission. Do not code [[Past history of Covid-19 infection]] until the next hospital admission.

~~==== When to code an [[Admit Diagnosis]] / Admit Procedure ====~~

* Dx/Procedure happened prior to physical arrival in their bed on unit/ward

* Dx/Procedure is '''still relevant to the admission'''

* '''Do not include old diagnoses that have been resolved~~.'''~~

** '''Example to code''': patient admitted with a [[Community-acquired pneumonia (CAP) in ICD10|CAP]] to ICU who was intubated, ventilated and placed on antibiotics. They develop [[Atrial fibrillation and/or atrial flutter]] and are placed on meds which may need adjusting because they are still having breakthrough rapid Afib. Once extubated they are often ready for the medicine ward but are still on antibiotics for their CAP and require watching to see if their Afib returns. The medicine collector would list both CAP and Afib as part of their admitting diagnoses.

** '''Example not to code''' would be a patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated.

===== ~~Past medical~~ history =====

{{Ex |*Patient had the left lung removed 7 years ago. Dont code the removal of the lung CCI, but instead code '''[[Past history, removal of all or part of lung]]'''

~~There~~ is, in ~~ICD10~~, ~~a small list of codes that represent previous~~ ''~~procedures~~'' ~~or medical situations~~ that ~~can~~'t ~~be captured~~ in ~~another way~~.

*For someone who had a [[Cardiac arrest]] in the past, don't code that as a [[Comorbid Diagnosis]] in future admissions, but instead DO code the cause of the cardiac arrest, e.g. an arrythmia, or coronary artery disease, etc.

*Patient has hypertension for which she takes medications and it is well controlled, but not related to the reasons for admission. '''Code this''', because even if not part of the reason for the current admission, the hypertension IS relevant to this person's chronic medical situation and thus SHOULD be coded, as a [[Comorbid Diagnosis]].

*Patient had [[ARDS (noncardiogenic pulmonary edema)]] a few years ago, and while ARDS is only an acute problem and thus is no longer active, his lungs never fully recovered and he has [[Respiratory failure (insufficiency), chronic]] which should be coded as a [[Comorbid Diagnosis]].

*Chronic and ongoing old conditions should be coded -- as a [[Comorbid Diagnosis]] if not part of the reason for this admission. }}

==== Some diagnoses can/should be coded as BOTH [[Admit Diagnosis]] and [[Comorbid Diagnosis]] ====

If a dx is chronic but also actively treated during this admission, code it as both [[Admit Diagnosis]] and [[Comorbid Diagnosis]].

{{Ex |

* ex1: Patient who has been, and still is, being treated for active pulmonary TB as an outpatient, and is admitted for an acute MI. Here since on the current admission the TB is still being actively treated, it qualifies as an [[Admit Diagnosis]], as above. But because it has been present from long before this admission, it also qualifies as an "active" [[Comorbid Diagnosis]].

* ex2: Patient has a past history of CHF and thus it should be coded as a [[Comorbid Diagnosis]]. And if the CHF is worse at admission and it is part of the reason for admission, then CHF should also be an [[Admit Diagnosis]].

}}

==== Recurrent conditions ====

* Do '''not code''' a recurrent condition that is NOT currently present -- if currently active, include as [[Admit Diagnosis]], otherwise don't code it

{{Ex |

* Ex1: Recurrent pneumonia -- in between the infections, there IS NO pneumonia}}

* '''Do code''' conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.

{{Ex |* Ex2: [[Asthma, without acute exacerbation]] -- this '''is'' a chronic disease whose nature is intermittent symptoms, but in between those symptoms the person still has asthma.}}

==== Past medical history ====

~~{{DiscussAllan |~~

* Should these then only ever be coded as [[Comorbid Diagnosis]]? If so we will likely need a {{CCMDB Data Integrity Checks|needs review}} for this. }}

~~==== When to code a [[Comorbid Diagnosis]] ====~~

*Many ICD10 diagnosis code can be used as a comorbid/pre-existing diagnosis -- the general criterion is that it was present PRIOR to admission

~~{{DiscussAllan | * prior~~ to ~~admission to this ward/unit, or prior to this hospital admission? EG long stay patients~~... }}

=== [[Controlling Dx Type for ICD10 codes]] ===

This wiki page talks about which ICD10 codes are ''allowed'' to be [[Comorbid Diagnosis]] vs. [[Admit Diagnosis]] vs. [[Acquired Diagnosis]] [[Dx Type]]. See [[Controlling Dx Type for ICD10 codes]] for a discussion about cross-checks for these.

~~'''AND is still present and clinically relevant.'''~~ {{~~DiscussAllan~~ | ~~that is awfully similar~~ to ~~the admit dx criteria~~... ~~is level of acuity the main distinction? Or duration of prior existence? }}~~

=== Legacy - did not use to code [[Comorbid Diagnoses]] only discovered during this admission ===

**If the ~~diagnosis under consideration qualifies~~ as ~~an '''~~[[~~Admit Diagnosis~~]]~~''', then in general it is not appropriate to code it as a comorbidity.~~

{{Collapsable

**If the diagnosis is acute then in general it is not appropriate to code it as a comorbidity.

| always= see how this used to be coded...

*Code these even if the diagnosis of the condition was only made during the current ~~hospital~~ admission but ~~it is quite clear that it must have existed before~~ admission ~~(even if that wasn't known)~~.

| full=

**Example 1: If a patient is admitted with pneumonia and on further workup is found to have CA of the lung, then this is coded in comorbid as it is obvious that the cancer must have been there for a while prior to admission.

*As of June 25, 2020, the rules were revised for coding as [[Comorbid Diagnoses]] those diagnosed during the current hospitalization (either at admission or thereafter) but which virtually certainly were present pre-admission.

**Example 2: Patient comes in with abdominal pain. Diagnosed as gastroenteritis but incidentally pt is found to be HIV +ve. You would code HIV +ve as a comorbid. Again, this is obvious that the pt had this problem for a while prior to admission to the hospital.

}}

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 ----
-</noinclude>{{DiscussAllan | Integrated content from two pages into a template. Likely no questions, but could you check if this is what you actually had in mind for the below? }}
+</noinclude>
-=== When to use Comorbid vs Admit Diagnosis or neither ===
+=== When to use [[Comorbid Diagnosis]] vs [[Admit Diagnosis]] or neither ===
 ==== When not to code a dx at all ====
-* Dx was present in the past but is not relevant to current admission
+*Dx was present in the past but that problem is '''resolved''' AND does not fit into one of the [[:Category: Past medical history]] codes
-** '''Example''': patient had appendix removed 7 years ago and is now admitted with injuries from a car accident; don't code the appendix removal at all.
+**To be clear on this -- do NOT code past problems that are fully resolved unless they are one of the [[:Category: Past medical history]] codes
+* Do not code diagnoses that occur during this admission as a comorbid diagnoses.  If they have completely resolved then do not code as a comorbid diagnosis until the next admission if applicable.  ie. surgical ward had a COVID pneumonia resolved prior to ICU admission.  Do not code [[Past history of Covid-19 infection]] until the next hospital admission.
-==== When to code an [[Admit Diagnosis]] / Admit Procedure ====
+{{ICD10 Guideline Stroke resolved exception}}
-* Dx/Procedure happened prior to physical arrival in their bed on unit/ward
-* Dx/Procedure is '''still relevant to the admission'''
-* '''Do not include old diagnoses that have been resolved.'''
-** '''Example to code''': patient admitted with a [[Community-acquired pneumonia (CAP) in ICD10|CAP]] to ICU who was intubated, ventilated and placed on antibiotics. They develop [[Atrial fibrillation and/or atrial flutter]] and are placed on meds which may need adjusting because they are still having breakthrough rapid Afib. Once extubated they are often ready for the medicine ward but are still on antibiotics for their CAP and require watching to see if their Afib returns. The medicine collector would list both CAP and Afib as part of their admitting diagnoses.
-** '''Example not to code''' would be a patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated.
-===== Past medical history =====
+{{Ex |*Patient had the left lung removed 7 years ago. Dont code the removal of the lung CCI, but instead code '''[[Past history, removal of all or part of lung]]'''
-There is, in ICD10, a small list of codes that represent previous ''procedures'' or medical situations that can't be captured in another way.
+*For someone who had a [[Cardiac arrest]] in the past, don't code that as a [[Comorbid Diagnosis]] in future admissions, but instead DO code the cause of the cardiac arrest, e.g. an arrythmia, or coronary artery disease, etc.
+*Patient has hypertension for which she takes medications and it is well controlled, but not related to the reasons for admission. '''Code this''', because even if not part of the reason for the current admission, the hypertension IS relevant to this person's chronic medical situation and thus SHOULD be coded, as a [[Comorbid Diagnosis]].
+*Patient had [[ARDS (noncardiogenic pulmonary edema)]] a few years ago, and while ARDS is only an acute problem and thus is no longer active, his lungs never fully recovered and he has [[Respiratory failure (insufficiency), chronic]] which should be coded as a [[Comorbid Diagnosis]].
+*Chronic and ongoing old conditions should be coded -- as a [[Comorbid Diagnosis]] if not part of the reason for this admission. }}
+==== Some diagnoses can/should be coded as BOTH [[Admit Diagnosis]] and [[Comorbid Diagnosis]] ====
+If a dx is chronic but also actively treated during this admission, code it as both [[Admit Diagnosis]] and [[Comorbid Diagnosis]].
+{{Ex |
+* ex1: Patient who has been, and still is, being treated for active pulmonary TB as an outpatient, and is admitted for an acute MI.  Here since on the current admission the TB is still being actively treated, it qualifies as an [[Admit Diagnosis]], as above.  But because it has been present from long before this admission, it also qualifies as an "active" [[Comorbid Diagnosis]].
+* ex2: Patient has a past history of CHF and thus it should be coded as a [[Comorbid Diagnosis]].  And if the CHF is worse at admission and it is part of the reason for admission, then CHF should also be an [[Admit Diagnosis]].
+}}
+==== Recurrent conditions ====
+* Do '''not code''' a recurrent condition that is NOT currently present -- if currently active, include as [[Admit Diagnosis]], otherwise don't code it
+{{Ex |
+* Ex1: Recurrent pneumonia -- in between the infections, there IS NO pneumonia}}
+* '''Do code''' conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.
+{{Ex |* Ex2: [[Asthma, without acute exacerbation]] -- this '''is'' a chronic disease whose nature is intermittent symptoms, but in between those symptoms the person still has asthma.}}
+==== Past medical history ====
+{{ICD10 Guideline Past medical history}}
 {{ListICD10Category | categoryName = Past medical history}}
-{{DiscussAllan |
-* Should these then only ever be coded as [[Comorbid Diagnosis]]? If so we will likely need a {{CCMDB Data Integrity Checks|needs review}} for this. }}
-==== When to code a [[Comorbid Diagnosis]] ====
-*Many ICD10 diagnosis code can be used as a comorbid/pre-existing diagnosis -- the general criterion is that it was present PRIOR to admission
-{{DiscussAllan | * prior to admission to this ward/unit, or prior to this hospital admission? EG long stay patients... }}
+=== [[Controlling Dx Type for ICD10 codes]] ===
+This wiki page talks about which ICD10 codes are ''allowed'' to be [[Comorbid Diagnosis]] vs. [[Admit Diagnosis]] vs. [[Acquired Diagnosis]] [[Dx Type]]. See [[Controlling Dx Type for ICD10 codes]] for a discussion about cross-checks for these.
-'''AND is still present and clinically relevant.''' {{DiscussAllan | that is awfully similar to the admit dx criteria... is level of acuity the main distinction? Or duration of prior existence? }}
+=== Legacy - did not use to code [[Comorbid Diagnoses]] only discovered during this admission ===
-**If the diagnosis under consideration qualifies as an '''[[Admit Diagnosis]]''', then in general it is not appropriate to code it as a comorbidity.
+{{Collapsable
-**If the diagnosis is acute then in general it is not appropriate to code it as a comorbidity.
+| always= see how this used to be coded...
-*Code these even if the diagnosis of the condition was only made during the current hospital admission but it is quite clear that it must have existed before admission (even if that wasn't known).
+| full=
-**Example 1: If a patient is admitted with pneumonia and on further workup is found to have CA of the lung, then this is coded in comorbid as it is obvious that the cancer must have been there for a while prior to admission.
+*As of June 25, 2020, the rules were revised for coding as [[Comorbid Diagnoses]] those diagnosed during the current hospitalization (either at admission or thereafter) but which virtually certainly were present pre-admission.
-**Example 2: Patient comes in with abdominal pain. Diagnosed as gastroenteritis but incidentally pt is found to be HIV +ve. You would code HIV +ve as a comorbid. Again, this is obvious that the pt had this problem for a while prior to admission to the hospital.
+}}