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| *In general, when you have a manifestation and a cause, the two codes should be combined. | | *In general, when you have a manifestation and a cause, the two codes should be combined. |
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| === Combined Codes when coding the [[Primary Admit Diagnosis]] === | | === Primary Admit Diagnosis in Combined Codes === |
| Sometimes an entity best represented as a combined code will be the [[Primary Admit Diagnosis]]. The way we use these means we don't want a patient to have two. Normal combined coding would lead to two diagnoses with the highest priority so we have to make a choice.
| | See [[Primary Admit Diagnosis]] |
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| The solution is to do '''BOTH''' of the following:
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| *For the #1, main reason for admission diagnosis, choose as #1 the diagnosis associated with the highest mortality, i.e. the one that’s “worst”'''. For example, for Liver failure due to Hep B, you'd usually choose the Liver failure as #1.
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| *ALSO separately code them together, i.e. combined. Yes, there's then some duplication in the diagnosis code list (in the example you'd code Liver failure as the #1 diagnosis, and also code the Liver failure combined with Hep B), but that's OK.
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| This solution also works for the rare entities which can only be coded with a combination of two codes. The example above of retroperitoneal hemorrhage is a good one if it's the #1 reason for admission. Here you'd code the '''[[Hemorrhage, NOS]]''' as #1, but ALSO code '''[[Hemorrhage, NOS]]''' combined with '''[[Retroperitoneal area, diagnostic imaging, abnormal]]'''
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| ==== different way to deal with Primary Dx in ICD10 codes ==== | | ==== different way to deal with Primary Dx in ICD10 codes ==== |