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

• Many ICD10 diagnosis code can be used as a comorbid/pre-existing diagnosis -- the general criterion is that it was present PRIOR to admission AND is still present and clinically relevant.
  • If the diagnosis under consideration qualifies as an Admit Diagnosis, then in general it is not appropriate to code it as a comorbidity.
  • If the diagnosis is acute then in general it is not appropriate to code it as a comorbidity.
• 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.

Past medical history

-There is, in ICD10, a small list of codes that represnt previous procedures or medical situations that can't be captured in another way -- category:Past medical history

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ICD 10

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

Template:DiscussAllan 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.

Template:ICD10 What will that mean for differences in data and reporting?

Patient has no comorbidities

If a patient has no comorbidities, enter No Comorbidities (ICD10 code).