Combined ICD10 codes: Difference between revisions

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== 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 it's just a matter of ensuring that the multiple codes are all in the diagnosis list.~~

*For some situations the multiple codes need to be '''''linked together''''' (we use the term "combined").

*For other 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 ~~that~~ 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.

*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.

=== Clinical Situation Plus it's 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.

=== Confusion about Combined Codes when coding the Main Admission Diagnosis ===

*If such a combined code is the #1 reason for admission, since combined diagnosis have the same priority, we have to make a choice.

*The solution is to do 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 (here there'd be Liver failure ''and'' Liver failure combined with Hep B), but that's OK.

=== Malignancy with Metastasis ===

*Here, code BOTH the primary site and the location(s) of mets -- and these need to be combined because the codes for mets don't specify the primary site, only the site of the mets.

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*Some, but not all fractures fall into this category of trauma/injury. See: [[Coding fractures in ICD10]]

=== Other co-codes? ===

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 == 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 it's just a matter of ensuring that the multiple codes are all in the diagnosis list.
+*For some situations the multiple codes need to be '''''linked together''''' (we use the term "combined").
-*For other 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 that 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.
+*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.
+=== Clinical Situation Plus it's 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.
+=== Confusion about Combined Codes when coding the Main Admission Diagnosis ===
+*If such a combined code is the #1 reason for admission, since combined diagnosis have the same priority, we have to make a choice.
+*The solution is to do 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 (here there'd be Liver failure ''and'' Liver failure combined with Hep B), but that's OK.
 === Malignancy with Metastasis ===
 *Here, code BOTH the primary site and the location(s) of mets -- and these need to be combined because the codes for mets don't specify the primary site, only the site of the mets.
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 {{ListICD10Category | categoryName = Mechanism}}
 *Some, but not all fractures fall into this category of trauma/injury.  See: [[Coding fractures in ICD10]]
 === Other co-codes? ===