Comorbid Diagnosis

For other diagnoses we collect see Admit Diagnosis or Acquired Diagnosis / Complication.

Comorbid Diagnoses are for diseases the patient has had for some time. Comorbidities can be a factor in increasing the patient risk of dying; see Charlson Comorbidity Index.

Collection Instructions

Code diagnoses that were obviously present prior to admission.

Code these even if the diagnosis of the condition was only made during the current hospital admission.

If a diagnosis is an acute event following long term comorbidity, code it as Admit Diagnosis instead.

• Example 1: if a patient is admitted with the DX of pneumonia and on further workup is found to have CA of the lung, then this is coded in comorbid as it is obvious that is process has been there for a while prior to admission.
• Example 2: patient comes in with abdominal pain. DX 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. If you don't code it as a comorbid until the patients show up again the next time to the hospital you have missed information. It is better to over report than under report.
• Example 3:If a pt is having CABG surgery and in the same admission, prior to the surgery, had an acute MI, the MI should also be listed as part of the diagnosis after the CABG. If the pt had an MI in a previous admission, this would be a comorbid.

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ICD 10

Template:ICD10 This is how this will be done in ICD10. For example, we only used to allow a subset of all diagnosis codes as comorbids. We will now allow all, right? What will that mean for differences in data and reporting?

Coding for comorbid dxs will follow the general ICD10 collection instructions.

Priorities

You will need to enter priorities for comorbids to group them for Combined ICD10 codes. Don't worry about actually prioritizing them, for comorbids the priorities will only be used for grouping.

List limiting

In our old dx coding schema we would only allow certain codes as comorbidities. For example, a code implying an action (a surgery or pacemaker tweak) can not be a DX, nor can be a code that implies an acute state. Will we want to limit the ICD10 codes in the same way?

Template:ICD10 If so, we will need to decide what should go onto that list and how to best implement that. I would suggest adding a field on the wiki and then having me make some rule based updates. There will still be some tweaks required in the end, but it will be a start. I can then export this to ccmdb.mdb. I understand it would be easier to make this edit in an excel sheet but right now the wiki doesn't even use the same names for some dxs any longer where we have fixed typos or chosen to change a dx name, so even if we decided to do this in an excel sheet I really think we would need to wait until I have exported a new list. So, for now just a discussion whether we want to do this and wether a field like "canBeComo" would be how to do it, not yet the question how to populate that field.