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Template:ICD10 Guideline Como vs Admit: Difference between revisions

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{{DA | Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review}}
=== When to use [[Comorbid Diagnosis]] vs [[Admit Diagnosis]] or neither ===  
 
=== When to use Comorbid vs Admit Diagnosis or neither ===  
==== When not to code a dx at all ====
==== When not to code a dx at all ====
*Dx was present in the past but that problem is '''resolved''' AND does not fit into one of the [[:Category: Past medical history]] codes
*Dx was present in the past but that problem is '''resolved''' AND does not fit into one of the [[:Category: Past medical history]] codes
**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
**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
{{Ex |*Patient had the left lung removed 7 years ago. Code '''[[Past history, removal of all or part of lung]]'''
* 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.  
*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.
 
*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had [[ARDS (noncardiogenic pulmonary edema)]] a few years ago, and while ARDS is only an acute problem and thus is no longer active, his lungs never fully recovered and he has [[Respiratory failure (insufficiency), chronic]] which should be coded as a comorbid.
{{ICD10 Guideline Stroke resolved exception}}
*Chronic and ongoing old conditions should be coded -- as a comorbid if not part of the reason for this admission. }}


==== When to code an [[Admit Diagnosis]] ====
{{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]]'''  
* Dx was present '''prior''' to physical arrival in their bed on unit/ward
*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.
::'''AND'''
*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]].
* Dx is relevant to this admission in that it is either:
*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]].
**(a) an acute or exacerbated condition (as opposed to a chronic, stable condition -- e.g. stable diabetes), OR
*Chronic and ongoing old conditions should be coded -- as a [[Comorbid Diagnosis]] if not part of the reason for this admission. }}
**(b) it is a condition not directly related to the reason(s) for admission, but its treatment is being '''actively''' managed -- and by actively we mean that during this admission changes are made to the management.
*Examples:
{{Ex |
*Patient with TB has been treated for the past 5 (of his 9 expected) months admitted now for acute MI.
**Scenario#1:No changes made in his TB treatment ---> so NOT an admit dx.
**Scenario#2:Changes are made to his TB treatment during this admission ---> so IS an admit dx too}}


==== When to code a [[Comorbid Diagnosis]] ====
==== Some diagnoses can/should be coded as BOTH [[Admit Diagnosis]] and [[Comorbid Diagnosis]] ====
* EITHER:
If a dx is chronic but also actively treated during this admission, code it as both [[Admit Diagnosis]] and [[Comorbid Diagnosis]].
**Dx is '''chronic''' (which includes NOT being fully resolved) and was present '''prior''' to admission OR
{{Ex |  
**Dx is in the past and is resolved and is included in one of the: [[:Category: Past medical history]] codes
* 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]].
** 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). Here are some examples of that situation:
* 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]]. 
{{Ex |* 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. 
}}
* 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.}}
*'''Some diagnoses can/should be coded as BOTH admit and comorbid''':
**example: 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" comorbidity.


===== Recurrent conditions =====
==== Recurrent conditions ====
* Do '''not code''' recurrent acute conditions that resolve between recurrences; for these, if currently active, include as [[Admit Diagnosis]], otherwise don't code them.
* Do '''not code''' a recurrent condition that is NOT currently present -- if currently active, include as [[Admit Diagnosis]], otherwise don't code it
{{Ex |* Recurrent pneumonia -- although one can be left with chronic sequelae of pneumonia (e.g. a pneumatocele or a region of emphysema or a bulla), in between these infections, there IS NO pneumonia
{{Ex |
* Recurrent severe sepsis -- same as above}}
* 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.  
* '''Do code''' conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.  
{{Ex |* [[Asthma, without acute exacerbation]] -- this '''is'' a chronic disease whose nature is intermittent symptoms, but in between those symptoms the person still has asthma.
{{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.}}
* [[COPD, without exacerbation]]}}


*So, for chronic conditions that are at their baseline at admission, code those as [[Comorbid Diagnosis]] -- e.g. COPD. 
==== Past medical history ====
**This "baseline" could include either of:  not currently getting any treatment; getting maintenance/control treatment.
{{ICD10 Guideline Past medical history}}
**Obviously, if the chronic condition (e.g. COPD) is in exacerbation at admission, then it should be coded as [[Admit Diagnosis]] -- e.g [[COPD, acute exacerbation]]
 
===== Past medical history =====
[[:Category:Past medical history]] contains codes that should only be captured as [[Comorbid Diagnosis]] that represent ''previous'' procedures or medical situations that can't be captured in another way. Their names usually follow the pattern "Past history of X" or "Artifical opening, has one".
{{ListICD10Category | categoryName = Past medical history}}
{{ListICD10Category | categoryName = Past medical history}}


===When a diagnosis can be coded as BOTH a comorbid and either acute or acquired ===
=== [[Controlling Dx Type for ICD10 codes]] ===
*This may occur
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.
{{Ex | *Patient has a past history of CHF and thus it should be coded as a comorbid.  And if the CHF is worse at admission and it is part of the reason for admission, then CHF should also be an admit code too. If instead, CHF is stable at admit, but worsens after admit, then the CHF could be an acute/acquired diagnosis}}


=== [[Controlling Dx Type for ICD10 codes]] ===
=== Legacy - did not use to code [[Comorbid Diagnoses]] only discovered during this admission ===
This wiki page talks about which ICD10 codes are ''allowed'' to be Comorbid vs. Acute vs. Acquired diagnosis type. See [[Controlling Dx Type for ICD10 codes]] for a discussion about cross-checks for these.
{{Collapsable
| always= see how this used to be coded...
| full= 
*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.
}}
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