Combined ICD10 codes

To code some diagnoses as part of ICD10 collection, several lines of entries in the Patient viewer tab ICD10 need to be grouped together.

To group diagnoses together, use the same Dx Priority for all of them.

Coding instructions

Introduction

• There are numerous situations in which multiple codes need to be listed in order to accurately reflect what's going on medically.
• For some situations the multiple codes need to be linked together (we use the term "combined").
• For other situations it's just a matter of ensuring that the multiple codes are all in the diagnosis list -- i.e. they don't need to be combined.
• For some entities there is no single ICD10 code, and the only way to code the entity is to combine two codes.
  • An example is that to identify Retroperitoneal hemorrhage one must link two codes Hemorrhage, NOS and Retroperitoneal area, diagnostic imaging, abnormal. So, alongside each of those is a message about this.
  • Another example is coding Hospital-acquired pneumonia. To get this you combine Iatrogenic, complication of medical or surgical care NOS with the appropriate type of pneumonia code, e.g. Pneumonia, bacterial or Pneumonia, fungal/yeast

Clinical Situation Plus its Cause

• Many ICD10 codes are for manifestations of disease, not a specific disorder per se.
• In their Wiki articles it will say something like "also code cause if known" e.g: Hematemesis (upper GI bleed/hemorrhage), NOS
• If the cause is an infection, the Wiki article will instruct to "also code infection source", e.g: Shock, septic
• In general, when you have a manifestation and a cause, the two codes should be combined.

Combined Codes when coding the Primary Admit Diagnosis

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.

The solution is to do BOTH of the following:

• 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.
• 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.

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

different way to deal with Primary Dx in ICD10 codes

Double coding like that will be a bit of a nuisance, and it will also make counting dxs etc harder since sometimes codes with priority 1 will need to be excluded. If we added a column "primary" to the L_ICD10 table, and required a single check and no more for each patient, I think that would be easier for coding and easier for entering. Julie, would that work for you? Ttenbergen 14:29, 2017 November 26 (CST)

Some specific cases

Other co-codes

• In addition to the combined coding situations listed above, you can combine codes when it makes sense to you to do so. The general guideline should be that codes be combined (instead of just both listed in the diagnosis list) when they are strongly related to each other.
• Use your judgement. Either listing them separately, or combined ensures that they're all there.

Transition notes

Yes, this different from how we used to use dx priorities where they had to be unique.

Data

The records are combined by same L_ICD10.Dx Priority.