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</noinclude>{{DiscussAllan | Integrated content from two pages into a template. Likely no questions, but could you check if this is what you actually had in mind for the below? }}
</noinclude>{{DiscussAllan | 1 template
Integrated content from two pages into a template. Likely no questions, but could you check if this is what you actually had in mind for the below? }}
=== When to use Comorbid 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 is not relevant to current admission
* Dx was present in the past but is not relevant to current admission
** '''Example''': 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.
** including earlier on during a long admission - if resolved, don't code
{{Collapsable
| always= Examples 
| full=*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. }}


==== When to code an [[Admit Diagnosis]] / Admit Procedure ====
==== When to code an [[Admit Diagnosis]] ====
* Dx/Procedure happened prior to physical arrival in their bed on unit/ward
* Dx happened prior to physical arrival in their bed on unit/ward
*{{Discussion}} See [[Px Type]] Should the Px Type = admit info/criteria found there be included/incorporated or a redirect included here so that collection instructions are consistent/complete?
* Dx '''still relevant to the admission'''
For Example admit CCI criteria  taken from Px Type = Admit:
{{Collapsable
*Code a '''procedure as admit''' if it was:
| always= Example to code
| full=* Patient admitted with a [[Community-acquired pneumonia (CAP) in ICD10|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.}}
{{Collapsable
| always= Example not to code
| full=* Patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated. }}


*(a) Performed within 24 hrs BEFORE the Arrive DtTm AND
==== 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).
{{Collapsable
| always= Examples
| full=* 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.}}


*(b) Was CAUSALLY related to the admission --  
===== 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.
{{Collapsable
| always= Example of recurrent Dxs not to code
| full=* 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.
{{Collapsable
| always= Example of ongoing Dxs with recurrent episodes that '''should''' be coded
| full=*  [[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. 
* Dx/Procedure is '''still relevant to the admission'''
**This "baseline" could include either of:  not currently getting any treatment; getting maintenance/control treatment.
* '''Do not include old diagnoses that have been resolved.'''
**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]]
** '''Example to code''': patient admitted with a [[Community-acquired pneumonia (CAP) in ICD10|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''' would be a patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated.


===== Past medical history =====
===== Past medical history =====
There is, in ICD10, a small list of codes that represent previous ''procedures'' or medical situations that can't be captured in another way.
There is, in ICD10, a small list of codes that represent previous ''procedures'' or medical situations that can't be captured in another way.
{{ListICD10Category | categoryName = Past medical history}}
{{ListICD10Category | categoryName = Past medical history}}
{{DiscussAllan |
* Should these then only ever be coded as [[Comorbid Diagnosis]]? If so we will likely need a {{CCMDB Data Integrity Checks|needs review}} for this.  Auditing incoming data and seeing alot of codes that perhaps should not even be in como slot such as, pneumonia, severe sepsis, medical non compliance.  We need to review at set up in access what is or is not allowed in certain fields.
**[[Controlling Dx Type for ICD10 codes]] }}


==== When to code a [[Comorbid Diagnosis]] ====
*An issue in coding chronic comorbid conditions is that in addition to the "usual" ICD10 diagnoses of conditions that could be listed there, ICD10 has a bunch of codes that indicate explicitly either "Past history of X" or "Artifical opening, has one".  These are included in here:
*Many ICD10 diagnosis code can be used as a comorbid/pre-existing diagnosis -- the general criterion is that it was present PRIOR to admission
{{ListICD10Category | categoryName = Past history}}


{{DiscussAllan | * prior to admission to this ward/unit, or prior to this hospital admission? EG long stay patients... }}
{{Collapsable
| always= Example of past history
| full=*an old, presumably cured, cancer}}


'''AND is still present and clinically relevant.''' {{DiscussAllan | that is awfully similar to the admit dx criteria... is level of acuity the main distinction? Or duration of prior existence? }}
==== [[Controlling Dx Type for ICD10 codes]] ====
**If the diagnosis under consideration qualifies as an '''[[Admit Diagnosis]]''', then in general it is not appropriate to code it as a comorbidity.
Should e.g. [[:Category:Past history]] codes then only ever be coded as [[Comorbid Diagnosis]]? If so we will likely need a {{CCMDB Data Integrity Checks|needs review}} for this. Auditing incoming data and seeing alot of codes that perhaps should not even be in como slot such as, pneumonia, severe sepsis, medical non compliance. We need to review at set up in access what is or is not allowed in certain fields.
**If the diagnosis is acute then in general it is not appropriate to code it as a comorbidity.
**[[Controlling Dx Type for ICD10 codes]]
*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).
**Example 1: 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.
**Example 2: 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.
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