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.
- There are some Dxs that can only be expressed as combinations, see #Some specific cases
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
- 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.
- For example, in Septic Shock that has led to liver failure, the two should be coded with the same priority.
Primary Admit Diagnosis in Combined Codes
Dxs that can only be expressed as combinations
Some entities can only be coded with a combination of two codes.
Examples:
- retroperitoneal hemorrhage; code combined
- Hospital-acquired pneumonia (HAP) in ICD10
Questions and concerns
Template:DiscussionTemplate:ICD10
- When coding septic shock, should we put in the organ damage issues connected to the septic shock code with the same priority number? ie. liver problems, renal problems, thrombocytopenia, etc. related to the shock? If we don't do this we don't really have a shock liver code so with the current list there is nothing to show this link. Just need to clarify this. It is tricky because there can be multiple causes of organ damage even in the same patient.--LKolesar 13:26, 2018 February 8 (CST)
- Yes you should. See Combined ICD10 codes. Mind you it was kind of hidden, so I used your example to emphasize. However, I guess sometimes one of the codes will be an admit and the other an acquired. Not sure how we will deal with that one. Still needs to be addressed. Ttenbergen 22:03, 2018 March 20 (CDT)
Some specific cases
Template:Combined dx metastasis primary Template:Trauma w mechanism Template:ICD10 infection Template:ICD10 Guideline Combined dx AB resistancee Template:ICD10 Symptoms not needed when cause known
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.