Template:ICD10 Guideline Como vs Admit

This template is used in Comorbid Diagnosis and Admit Diagnosis to give consistent instructions when to use either or neither.

To use:

{{ICD10 Guideline Como vs Admit}}

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When to use Comorbid vs Admit Diagnosis or neither

When not to code a dx at all

• Dx was present in the past but is not relevant to the patient's current medical status (acute or chronic)
  • including earlier on during a long admission - if resolved, don't code

Examples

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. Patient had the left lung removed 7 years ago. THIS IS relevant to his medical status because the guy only has 1 lung now. Similar if he had his spleen removed in the past. Patient has hypertension that's well controlled and not at all an issue related to the reasons for admission, but nonetheless, the hypertension IS relevant to this person's chronic medical situation and thus SHOULD be coded, as a comorbid.

When to code an Admit Diagnosis

• Dx happened prior to physical arrival in their bed on unit/ward
• Dx is relevant to this admission

Example to code

Patient admitted with a 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

Patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated.

When to code a Comorbid Diagnosis

• Dx does not qualify as an Admit Diagnosis and is chronic and was present prior to admission
  • 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).

Examples

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.

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.

Example of recurrent Dxs not to code

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 Recurrent severe sepsis -- same as above

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

Example of ongoing Dxs with recurrent episodes that should be coded

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 in this bin -- e.g. COPD.
  • This "baseline" could include either of: not currently getting any treatment; getting maintenance/control treatment.
  • Obviously, if the chronic condition (e.g. COPD) is in exacerbation at admission, then it should be listed under the bin 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".

Controlling Dx Type for ICD10 codes

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.