Admit Diagnosis: Difference between revisions

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''For other diagnoses, see [[Comorbid Diagnosis]] and [[Acquired Diagnosis / Complication]].''

'''Admit diagnoses''' are what led to the patient's ~~admission~~ to ~~your unit~~. We make special use of the [[Primary Admit Diagnosis]], so make sure the ~~'''most responsible reason''' why the patient was admitted is given the highest priority~~.

'''Admit diagnoses''' are what led to the start of the patient's current [[PatientFollow Project]] profile. An Admit Diagnosis is coded by setting the [[Dx_Type]] to "admit". We make special use of the [[Primary Admit Diagnosis]], so make sure you consider the content there.

== ~~Admit Diagnosis coding restrictions by admit-from location ==~~

== Collection Instructions ==

''Note: this is a summary from the defunct article ''! Diagnostic Coding Pointers''. I am cleaning out that article and dispersing its contents to the respective articles. If necessary, please comment here. [[User:Ttenbergen|Ttenbergen]] 16:51, 25 July 2011 (CDT) ''

~~=== should some of these be eliminated =~~==

~~I think the following instructions should be eliminated for the following reasons:~~

* they are too complex; as such people are going to misunderstand them or forget to apply them. Better to stick to the "most important rule" and supplement it with [[General Diagnosis Coding Guidelines]] (these may have to be amended)

* they make special cases out of some diagnoses while leaving others out. For example, why is the reason for a CABG self-evident, but not the reason for an appendectomy?

* some of these contradict the general definition of the admit diagnosis being the "most responsible" diagnosis; when our data is analyzed with that definition in mind then these rules will lead to misrepresentation

* some collectors will stick to these rules even if they get a sense that it will misrepresent the situation; others will code to make sense of the situation as suggested by [[General Diagnosis Coding Guidelines]], yet others will have missed either in all the information, so these rules don't necessarily result in clean data, even if that is the intent.

I think the rules should be deleted, and only the first paragraph of this article should count. If we have such a thing as "surgery wants to know what procedures happen" then mention that in the [[General_Diagnosis_Coding_Guidelines#Consider_what_we_use_the_data_for]] section, e.g. mention Dr Kumar's interest in infections and to code them preferentially even if something more urgent is present (if that's what we want to to) but keep it general.

* What are your thoughts? [[User:Ttenbergen|Ttenbergen]] 17:05, 25 July 2011 (CDT)

** Re-flagging proposal for change. Will change as proposed after 2012-09-30 if no objections noted in here. [[User:Ttenbergen|Ttenbergen]] 18:45, 2012 September 6 (CDT)

~~=== Operating room ===~~

~~==== Non-Trauma====~~

*PROCEDURE(S) FOLLOWED BY THE REASON(S) FOR THE PROCEDURE

*EXCEPTIONS:

**CABG: SELF-EXPLANATORY NO REASON REQUIRED

**VALVE REPLACEMENT AND CABG: CODE HEART VALVE SURGERY CODE

**CABG SECOND FOLLOWED BY THE REASON OR HEART VALVE PROBLEM

~~==== Trauma====~~

~~USE TRAUMA CODES "POST OP" FIRST FOLLOWED BY TRAUMA CODES "NON POST OP" FOR SIGNIFICANT INJURIES NOT OPERATED ON.~~

* {{discussion}} is that true? What if a less major problem was operated on - wouldn't we want to list the more-major unoperated problem higher? [[User:Ttenbergen|Ttenbergen]] 13:58, 27 July 2011 (CDT)

** actually, if I was right about the previous then the entire OR instructions could become something like "list procedure or trauma that was primary reason for OR, followed by other diagnoses or procedures in order of their importance to the patient having been admitted" (feel free to tweak). [[User:Ttenbergen|Ttenbergen]] 14:00, 27 July 2011 (CDT)

***I don't see why trauma should have any special precedence as admit codes. Why can't the rule to use the most responsible diagnosis as for all other coding? I think Trish may know why trauma codes were given some higher status??? to me a cardiac arrest or shock are far more important and a more likely reason for admisssion to an ICU--[[User:LKolesar|LKolesar]] 14:45, 27 July 2011 (CDT)

~~=== Emergency Room===~~

~~==== Non-Trauma====~~

~~MOST RESPONSIBLE DIAGNOSIS FIRST FOLLOWED BY THE SECOND MOST COMPROMISING PROBLEM~~

~~==== Trauma====~~

~~MOST SIGNIFICANT PRIMARY INJURY FIRST FOLLOWED BY THE SECOND MOST COMPROMISING PROBLEM~~

* {{discussion}} is that true? Wouldn't we code a "shock" before a broken leg? [[User:Ttenbergen|Ttenbergen]] 13:56, 27 July 2011 (CDT)

** again, if I am right about that, then the instructions could be brought back to the standard most important first, nothing special about ER admission. [[User:Ttenbergen|Ttenbergen]] 14:01, 27 July 2011 (CDT)

~~==== Angio Lab====~~

EMERGENCY ROOM TO ANGIO-LAB FROM ER TO WARD OR UNIT: LIST PRIMARY PROCEDURE FIRST:ANGIOGRAM FOLLOWED BY ANGIOPLASTY AND THEN STENT IF DONE. FOLLOWED BY PROBLEM OR REASON FOR THE ANGIOGRAM (POSTINFARCT ANGINA/CHF,ETC) FOLLOWED BY REASON (TYPE OF MI) FOLLOWED BY THROMBOLYTICS IF APPLICABLE. EXCEPTION: IF CARDIOGENIC SHOCK OR CARDIAC ARREST IN ER OR ANGIO LAB LIST AS #1 REASON FOR ADMISSION

* Can one have an angioplasty w/o an angiogram? If not, why list angiogram. Can one have a stent without an angioplasty? If not, why list angioplasty?

**One can have an angiogram without a plasty or stent but you cannot have a plasty or stent without an angiogram. If a stent is coded, a plasty and angiogram has also been done. --[[User:LKolesar|LKolesar]] 14:50, 27 July 2011 (CDT)

* What do you mean "EMERGENCY ROOM TO ANGIO-LAB FROM ER TO WARD OR UNIT"? [[User:Ttenbergen|Ttenbergen]] 14:05, 27 July 2011 (CDT)

**This is poorly written. It should read primary angiogram done prior to arrival to the unit (usually come from an ER or even via ambulance from home). Again, while it is important to code this event, I don't see why it has to be coded first, as long as it is part of the admit codes. Maybe Trish can answer these questions. --[[User:LKolesar|LKolesar]] 14:50, 27 July 2011 (CDT)

~~=== Recovery Room===~~

LIST REASON FOR TRANSFER '''from''' RECOVER ROOM FOLLOWED BY SIGNIFICANT COMPLICATIONS INTRA-OP FOLLOWED BY SURGICAL PROCEDURE AND THEN THE REASON FOR THE SURGERY (EX.: #1) BPCONTROL #2) PAIN CONTROL POST-OP #3) WITNESSED (INTRA-OPERATIVE) CARDIAC ARREST #4) BOWEL RESECTION #5) BOWEL CA)

* {{discussion}} don't think I understand... maybe my question is really "how is admit from OR different from admit from recovery"? Wouldn't most people go to recovery first? [[User:Ttenbergen|Ttenbergen]] 14:08, 27 July 2011 (CDT)

**If a pt comes to the ICU direct from the OR we always code the procedure first because these can be planned admissions direct to the ICU (like heart surgery) or if the pt has complications during surgery, requiring an ICU bed. (These do not go to RR). If a pt is recovering from a surgical procedure in Recovery Room and develops complications requiring an ICU bed, then we usually put the reason they are coming to the ICU first like post op respiratory failure or post op bleeding, etc... The surgery itself alone did not bring the pt to the ICU in this case. --[[User:LKolesar|LKolesar]] 10:59, 28 July 2011 (CDT)

~~=== Ward===~~

~~PRIMARY REASON TO UNIT FOLLOWED BY other SIGNIFICANT REASON TO UNIT AND THEN RECENT SURGERY (WITHIN 4 DAYS OR SIGNIFICANT TO REASON FOR ADMISSION) SHOULD BE IDENTIFIED LAST.~~

*{{discussion}} should this not really be another question of listing things in the order of importance? Is it really right to mandate the surgery being last? Maybe it is really more important than the second most significant reason? CCMDB already won't allow a procedure as an admit dx from ward already (see [[Check ORDx]]), so we know it can't be first. [[User:Ttenbergen|Ttenbergen]] 14:12, 27 July 2011 (CDT)

**I think that is a valid point Tina --[[User:LKolesar|LKolesar]] 11:00, 28 July 2011 (CDT)

~~===Problems or Procedure PRIOR TO arrival onto unit===~~

Any medical problems or procedures that a patient had done PRIOR TO their '''physical arrival''' into a medicine or ICU ward bed are coded as part of admitting diagnosis and not as complications. An example of this would be medicine patients who '''are "accepted" to medicine ward service but have not yet arrived on the ward''' (ie [[ER Wait]]).

==Data Structure==

Admit Diagnoses are stored in [[~~L_Dxs~~]].

Admit Diagnoses are drawn from [[S_ICD10 table]] and stored in [[L_ICD10 table]].

== Legacy Information ==

=== Maximum Number of Admit Diagnoses ===

{{Collapsable

Until we started to use [[Centralized_data.~~mdb~~]] we were limited to 6 admit diagnoses.

| always= Maximum Number of Admit Diagnoses

~~Was ''The~~ [[CCMDB.~~mdb~~]] ~~can~~ record any number of admit diagnoses. However, only the '''six (6)''' with the highest priority ~~will be~~ appended to [[TMSX]]. ~~So, you can track as many diagnoses as you want as you go along, and then delete or re-prioritize to only send the most relevant.''~~

| full=

Until we started to use [[Centralized_data.accdb]] we were limited to 6 admit diagnoses.

For some time [[CCMDB.accdb]] had been able to record any number of admit diagnoses. However, only the '''six (6)''' with the highest priority were appended to [[TMSX]]. }}

===Related articles ===

[[Category: Diagnosis Coding | * ]]

[[Category:Data Collection Guide]]

[[Category: ~~Data Collection Guide~~ ]]

[[Category:ICD10]]

@@ Line 1: / Line 1: @@
 ''For other diagnoses, see [[Comorbid Diagnosis]] and [[Acquired Diagnosis / Complication]].''
-'''Admit diagnoses''' are what led to the patient's admission to your unit. We make special use of the [[Primary Admit Diagnosis]], so make sure the '''most responsible reason''' why the patient was admitted is given the highest priority.
+'''Admit diagnoses''' are what led to the start of the patient's current [[PatientFollow Project]] profile. An Admit Diagnosis is coded by setting the [[Dx_Type]] to "admit". We make special use of the [[Primary Admit Diagnosis]], so make sure you consider the content there.
-== Admit Diagnosis coding restrictions by admit-from location ==
+== Collection Instructions ==
-''Note: this is a summary from the defunct article ''! Diagnostic Coding Pointers''. I am cleaning out that article and dispersing its contents to the respective articles. If necessary, please comment here. [[User:Ttenbergen|Ttenbergen]] 16:51, 25 July 2011 (CDT) ''
+{{ICD10 Guideline Como vs Admit}}
+{{ICD10 Guideline Admit vs Acquired}}
-=== should some of these be eliminated ===
-{{discuss@task}}
-{{discussion}}
-I think the following instructions should be eliminated for the following reasons:
-* they are too complex; as such people are going to misunderstand them or forget to apply them. Better to stick to the "most important rule" and supplement it with [[General Diagnosis Coding Guidelines]] (these may have to be amended)
-* they make special cases out of some diagnoses while leaving others out. For example, why is the reason for a CABG self-evident, but not the reason for an appendectomy?
-* some of these contradict the general definition of the admit diagnosis being the "most responsible" diagnosis; when our data is analyzed with that definition in mind then these rules will lead to misrepresentation
-* some collectors will stick to these rules even if they get a sense that it will misrepresent the situation; others will code to make sense of the situation as suggested by [[General Diagnosis Coding Guidelines]], yet others will have missed either in all the information, so these rules don't necessarily result in clean data, even if that is the intent.
-I think the rules should be deleted, and only the first paragraph of this article should count. If we have such a thing as "surgery wants to know what procedures happen" then mention that in the [[General_Diagnosis_Coding_Guidelines#Consider_what_we_use_the_data_for]] section, e.g. mention Dr Kumar's interest in infections and to code them preferentially even if something more urgent is present (if that's what we want to to) but keep it general.
-* What are your thoughts? [[User:Ttenbergen|Ttenbergen]] 17:05, 25 July 2011 (CDT)
-** Re-flagging proposal for change. Will change as proposed after 2012-09-30 if no objections noted in here. [[User:Ttenbergen|Ttenbergen]] 18:45, 2012 September 6 (CDT)
-=== Operating room ===
-==== Non-Trauma====
-*PROCEDURE(S) FOLLOWED BY THE REASON(S) FOR THE PROCEDURE
-*EXCEPTIONS:
-**CABG: SELF-EXPLANATORY NO REASON REQUIRED
-**VALVE REPLACEMENT AND CABG: CODE HEART VALVE SURGERY CODE
-**CABG SECOND FOLLOWED BY THE REASON OR HEART VALVE PROBLEM
-==== Trauma====
-USE TRAUMA CODES "POST OP" FIRST FOLLOWED BY TRAUMA CODES "NON POST OP" FOR SIGNIFICANT INJURIES NOT OPERATED ON.
-* {{discussion}} is that true? What if a less major problem was operated on - wouldn't we want to list the more-major unoperated problem higher? [[User:Ttenbergen|Ttenbergen]] 13:58, 27 July 2011 (CDT)
-** actually, if I was right about the previous then the entire OR instructions could become something like "list procedure or trauma that was primary reason for OR, followed by other diagnoses or procedures in order of their importance to the patient having been admitted" (feel free to tweak). [[User:Ttenbergen|Ttenbergen]] 14:00, 27 July 2011 (CDT)
-***I don't see why trauma should have any special precedence as admit codes.  Why can't the rule to use the most responsible diagnosis as for all other coding?  I think Trish may know why trauma codes were given some higher status??? to me a cardiac arrest or shock are far more important and a more likely reason for admisssion to an ICU--[[User:LKolesar|LKolesar]] 14:45, 27 July 2011 (CDT)
-=== Emergency Room===
-==== Non-Trauma====
-MOST RESPONSIBLE DIAGNOSIS FIRST FOLLOWED BY THE SECOND MOST COMPROMISING PROBLEM
-==== Trauma====
-MOST SIGNIFICANT PRIMARY INJURY FIRST FOLLOWED BY THE SECOND MOST COMPROMISING PROBLEM
-* {{discussion}} is that true? Wouldn't we code a "shock" before a broken leg? [[User:Ttenbergen|Ttenbergen]] 13:56, 27 July 2011 (CDT)
-** again, if I am right about that, then the instructions could be brought back to the standard most important first, nothing special about ER admission. [[User:Ttenbergen|Ttenbergen]] 14:01, 27 July 2011 (CDT)
-==== Angio Lab====
-EMERGENCY ROOM TO ANGIO-LAB FROM ER TO WARD OR UNIT:  LIST PRIMARY PROCEDURE FIRST:ANGIOGRAM FOLLOWED BY ANGIOPLASTY AND THEN STENT IF DONE. FOLLOWED BY PROBLEM OR REASON FOR THE ANGIOGRAM (POSTINFARCT ANGINA/CHF,ETC) FOLLOWED BY REASON (TYPE OF MI) FOLLOWED BY THROMBOLYTICS IF APPLICABLE. EXCEPTION:  IF CARDIOGENIC SHOCK OR CARDIAC ARREST IN ER OR ANGIO LAB LIST AS #1 REASON FOR ADMISSION
-*  Can one have an angioplasty w/o an angiogram? If not, why list angiogram. Can one have a stent without an angioplasty? If not, why list angioplasty?
-**One can have an angiogram without a plasty or stent but you cannot  have a plasty or stent without an angiogram.   If a stent is coded, a plasty and angiogram has also been done.  --[[User:LKolesar|LKolesar]] 14:50, 27 July 2011 (CDT)
-*  What do you mean "EMERGENCY ROOM TO ANGIO-LAB FROM ER TO WARD OR UNIT"? [[User:Ttenbergen|Ttenbergen]] 14:05, 27 July 2011 (CDT)
-**This is poorly written.  It should read primary angiogram done prior to arrival to the unit (usually come from an ER or even via ambulance from home).   Again, while it is important to code this event, I don't see why it has to be coded first, as long as it is part of the admit codes.   Maybe Trish can answer these questions.  --[[User:LKolesar|LKolesar]] 14:50, 27 July 2011 (CDT)
-=== Recovery Room===
-LIST REASON FOR TRANSFER '''from''' RECOVER ROOM FOLLOWED BY SIGNIFICANT COMPLICATIONS INTRA-OP FOLLOWED BY SURGICAL PROCEDURE AND THEN THE REASON FOR THE SURGERY (EX.: #1) BPCONTROL #2) PAIN CONTROL POST-OP #3) WITNESSED (INTRA-OPERATIVE) CARDIAC ARREST #4) BOWEL RESECTION #5) BOWEL CA)
-* {{discussion}} don't think I understand... maybe my question is really "how is admit from OR different from admit from recovery"? Wouldn't most people go to recovery first? [[User:Ttenbergen|Ttenbergen]] 14:08, 27 July 2011 (CDT)
-**If a pt comes to the ICU direct from the OR we always code the procedure first because these can be planned admissions direct to the ICU (like heart surgery) or if the pt has complications during surgery, requiring an ICU bed. (These do not go to RR).  If a pt is recovering from a surgical procedure in Recovery Room and develops complications requiring an ICU bed, then we usually put the reason they are coming to the ICU first like post op respiratory failure or post op bleeding, etc...  The surgery itself alone did not bring the pt to the ICU in this case.   --[[User:LKolesar|LKolesar]] 10:59, 28 July 2011 (CDT)
-=== Ward===
-PRIMARY REASON TO UNIT  FOLLOWED BY other SIGNIFICANT REASON TO UNIT AND THEN RECENT SURGERY (WITHIN 4 DAYS OR SIGNIFICANT TO REASON FOR ADMISSION) SHOULD BE IDENTIFIED LAST.
-*{{discussion}} should this not really be another question of listing things in the order of importance? Is it really right to mandate the surgery being last? Maybe it is really more important than the second most significant reason? CCMDB already won't allow a procedure as an admit dx from ward already (see [[Check ORDx]]), so we know it can't be first. [[User:Ttenbergen|Ttenbergen]] 14:12, 27 July 2011 (CDT)
-**I think that is a valid point Tina --[[User:LKolesar|LKolesar]] 11:00, 28 July 2011 (CDT)
-===Problems or Procedure PRIOR TO arrival onto unit===
-Any medical problems or procedures that a patient had done PRIOR TO their '''physical arrival''' into a medicine or ICU ward bed are coded as part of admitting diagnosis and not as complications. An example of this would be medicine patients who '''are "accepted" to medicine ward service but have not yet arrived on the ward''' (ie [[ER Wait]]).
 ==Data Structure==
-Admit Diagnoses are stored in [[L_Dxs]].
+Admit Diagnoses are drawn from [[S_ICD10 table]] and stored in [[L_ICD10 table]].
 == Legacy Information ==
-=== Maximum Number of Admit Diagnoses ===
+{{Collapsable
-Until we started to use [[Centralized_data.mdb]] we were limited to 6 admit diagnoses.
+| always= Maximum Number of Admit Diagnoses
-Was ''The [[CCMDB.mdb]] can record any number of admit diagnoses. However, only the '''six (6)''' with the highest priority will be appended to [[TMSX]]. So, you can track as many diagnoses as you want as you go along, and then delete or re-prioritize to only send the most relevant.''
+| full=
+Until we started to use [[Centralized_data.accdb]] we were limited to 6 admit diagnoses.
+For some time [[CCMDB.accdb]] had been able to record any number of admit diagnoses. However, only the '''six (6)''' with the highest priority were appended to [[TMSX]]. }}
+{{Data Integrity Check List}}
+===Related articles ===
+{{Related Articles}}
-[[Category: Diagnosis Coding | * ]]
+[[Category:Data Collection Guide]]
-[[Category: Data Collection Guide ]]
+[[Category:ICD10]]