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.

Iatrogenic codes:
Acetaminophen (tylenol, paracematol), adverse effect Adrenal insufficiency, drug-induced (i.e. due to steroid administration) Anesthetic gas, adverse effect Anti-arrhythmic, adverse effect Anti-arrhythmic, overdose/toxicity Antibiotic/antimicrobial, adverse effect Antibiotic/antimicrobial, overdose/toxicity Anticoagulant, adverse effect Anticoagulant, overdose/toxicity Antidepressant drug NOS, adverse effect Antineoplastic/chemotherapy or immunosuppressive drugs, adverse effect Antineoplastic/chemotherapy or immunosuppressive drugs, overdose/toxicity Antiseizure drug NOS, adverse effect Antiseizure drug NOS, overdose/toxicity Aspirin or other salicylate or NSAID, adverse effect Benzodiazepine, adverse effect Bone marrow transplant, failure or rejection Calcium channel blocker drug, adverse effect Cardiac/cardiovascular drug NOS, adverse effect Cardiac/cardiovascular drug NOS, overdose/toxicity Cerebrospinal fluid (CSF) leak Complication associated with artificial fertilization, NOS Complication of anesthesia, NOS Cushing's syndrome, drug-induced Decubitus (pressure) ulcer, Stage I (surface reddening) Decubitus (pressure) ulcer, Stage II (to fascia, just under skin) Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle) Decubitus (pressure) ulcer, Stage IV (involves muscle, tendon, or bone) Decubitus (pressure) ulcer, stage not indicated Drug or biological substance/agent NOS, adverse effect Failed/difficult intubation, or complication of intubation Graft-versus-host disease/reaction (GVHD) Hallucinogen, adverse effect Heart transplant, failure or rejection or unspecified complication Heart-lung transplant, failure or rejection or unspecified complication Hemorrhage, due to anticoagulant or thrombolytic drug Heparin-induced thrombocytopenia (HIT) Hormone or hormone agonist NOS, overdose/toxicity Hormone or hormone agonist drug, adverse effect Hypotension, drug-induced Iatrogenic problem NOS, related to a surgery or procedure, NOS Iatrogenic, air embolism, as complication of line/infusion/transfusion/injection Iatrogenic, complication NOS, cardiac or vascular prosthetic device or implant or graft Iatrogenic, complication of medical or surgical care NOS Iatrogenic, dehiscence or rupture or disruption, surgical wound NOS Iatrogenic, hemorrhage or hematoma, related to a procedure or surgery NOS Iatrogenic, hypotension/shock, postoperative/post-procedural Iatrogenic, infection, cardiac or vascular prosthetic device or implant or graft NOS Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI) Iatrogenic, infection, following a procedure or surgery, NOS Iatrogenic, infection, heart valve prosthesis (incl prosthetic valve endocarditis) Iatrogenic, infection, internal orthopedic prosthetic device or implant or graft or bone device Iatrogenic, infection, internal prosthetic device or implant or graft NOS Iatrogenic, infection, related to vascular access other than central line Iatrogenic, infection, urinary catheter Iatrogenic, malignant hyperthermia, due to anesthesia Iatrogenic, mechanical complication/dysfunction, cardiac electronic device Iatrogenic, mechanical complication/dysfunction, cardiac or vascular prosthetic device or implant or graft, NOS Iatrogenic, mechanical complication/dysfunction, dialysis catheter Iatrogenic, mechanical complication/dysfunction, heart valve prosthesis Iatrogenic, mechanical complication/dysfunction, internal orthopedic prosthetic device or implant or graft or bone device Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS Iatrogenic, mechanical complication/dysfunction, urinary catheter Iatrogenic, puncture or laceration, related to a procedure or surgery NOS Iatrogenic, thromboembolism, as complication of line/infusion/transfusion/injection Iatrogenic, transfusion reaction (incompatibility reaction) (any type) Insulin or antidiabetic drug, adverse effect Liver transplant, failure or rejection or unspecified complication Lung transplant, failure or rejection or unspecified complication Neuropathy, peripheral, drug-induced Nosocomial infection, NOS Opioid/narcotic, adverse effect Pancreas transplant, failure or rejection or unspecified complication Pneumonia, ventilator-associated (VAP) Psychiatric drug NOS, adverse effect Psychiatric drug NOS, overdose/toxicity Rib fracture(s) due to CPR Sedative or hypnotic, adverse effect Skin rash, drug-induced (drug eruption) Stimulants incl. methamphetamine, poisoning Subglottic (tracheal) stenosis or tracheomalacia, iatrogenic Thrombolytic drug, adverse effect Thrombolytic drug, overdose/toxicity Transfusion-related acute lung injury (TRALI, form of ARDS) Transplanted organ NOS, failure or rejection or unspecified complication Tricyclic antidepressant, adverse effect Xray contrast agent, adverse effect

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

See Primary Admit Diagnosis

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
- Hemorrhage, NOS
- Retroperitoneal area, diagnostic imaging, abnormal
Hospital-acquired pneumonia (HAP) in ICD10

Questions and concerns

Template:Discussion Template: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

Malignancy with Metastasis

Metastasis and their primary tumor should be coded in combination because the codes for mets don't specify the primary site, only the site of the mets.

Codes for the mets can be found at:

Metastasis codes:
Adrenal gland, metastatic malignancy to it (also code primary site) Bone or bone marrow, metastatic malignancy to it (also code primary site) Brain or meninges, metastatic malignancy to it (also code primary site) Gastrointestinal system NOS, metastatic malignancy to it (also code primary site) Liver or biliary system, metastatic malignancy to it (also code primary site) Lung, metastatic malignancy to it (also code primary site) Lymph nodes, metastatic malignancy to them (also code primary site) Peritoneum, metastatic malignancy to it (also code primary site) Pleura, metastatic malignancy to it (also code primary site) Respiratory system NOS, metastatic malignancy to it (also code primary site) Site NOS, metastatic malignancy to it (also code primary site) Urinary system NOS, metastatic malignancy to it (also code primary site)

If the site of the mets isn't in the list, use Site NOS, metastatic malignancy to it (also code primary site)
If there are mets to multiple sites, then combine all together the primary malignancy code to the codes for the different sites of the mets.
If the mets are in the other of a paired organ (e.g. the other kidney), then code both the primary and the metastatic codes, and link them together

Codes for the primary tumors can be found at:

Neoplastic codes:
Acute erythroblastic leukemia (erythroleukemia) Acute lymphoblastic leukemia (ALL) Acute megakaryoblastic leukemia Acute myeloid leukemia (AML) Acute myelomonocytic leukaemia (AMML) Acute promyelocytic leukaemia (APL) Adrenal gland, benign neoplasm Adrenal gland, metastatic malignancy to it (also code primary site) Adrenal gland, primary malignancy Antineoplastic/chemotherapy or immunosuppressive drugs, adverse effect Antineoplastic/chemotherapy or immunosuppressive drugs, overdose/toxicity Benign neoplasm, NOS Biliary tract, primary malignancy Bladder, primary malignancy Bone NOS, pathologic fracture due to neoplastic disease Bone or bone marrow, metastatic malignancy to it (also code primary site) Bone or cartilage (any location), primary malignancy Bone or cartilage, benign neoplasm Brain or meninges, metastatic malignancy to it (also code primary site) Brain, primary malignancy Breast, benign neoplasm Breast, primary malignancy Carcinoid syndrome Carcinoma in situ, any site Central nervous system NOS, benign neoplasm Central nervous system NOS, primary malignancy Cervix, dysplasia Cervix, primary malignancy Chronic lymphocytic leukemia (CLL) Chronic myeloid leukemia (CML) Colon (large intestine) or rectum or anus, benign neoplasm Colon (large intestine), primary malignancy Connective or soft tissue NOS (external or internal), primary malignancy Digestive system NOS, benign neoplasm Disorder of anus or rectum, NOS Endocrine gland NOS, benign neoplasm Endocrine gland NOS, primary malignancy Esophagus, benign neoplasm Esophagus, primary malignancy Essential thrombocythemia/thrombocytosis Eye or related structures, benign neoplasm Eye, primary malignancy Fat, benign neoplasm Female genitalia NOS (internal or external), primary malignancy Female genitals, benign neoplasm Femur or pelvis, pathologic fracture due to neoplastic disease GI organ NOS, primary malignancy Gallbladder, primary malignancy Gastrointestinal system NOS, metastatic malignancy to it (also code primary site) Genetic susceptibility to malignant neoplasm Hairy cell leukemia Head and neck and face, primary malignancy Heart, benign neoplasm Heart, primary malignancy Hemangioma or lymphangioma, benign neoplasm, any site Hodgkin's lymphoma (Hodgkin's disease) Hypercalcemia, severe or symptomatic Intrathoracic structures NOS, benign neoplasm Kaposi's sarcoma Kidney or ureter or bladder or urethra, benign neoplasm Kidney, primary malignancy Larynx, benign neoplasm Larynx, primary malignancy Leukemia, NOS Lip or mouth or tonsils or pharynx, primary malignancy Liver or biliary system, benign neoplasm Liver or biliary system, metastatic malignancy to it (also code primary site) Liver, primary malignancy Lung and/or bronchus, primary malignancy Lung or bronchi, benign neoplasm Lung, metastatic malignancy to it (also code primary site) Lymph nodes, benign neoplasm Lymph nodes, metastatic malignancy to them (also code primary site) Lymphoid leukemia, NOS Lymphoma, NOS Male genitalia NOS (internal or external), primary malignancy Male genitals, benign neoplasm Malignancy (clonal disorder) of blood or lymphoid tissue, NOS Malignant carcinoid tumor Malignant immunoproliferative disease Mediastinum, primary malignancy Meninges, benign neoplasm Meninges, primary malignancy Mesothelioma (any site) Monoclonal gammopathy of undetermined significance (MGUS) Monocytic leukemia, acute or chronic Mouth or pharynx or salivary glands, benign neoplasm Multiple endocrine adenomatosis (multiple endocrine neoplasia syndrome, MEN) Multiple myeloma Myelodysplastic syndrome/myelodysplasia (preleukemia, refractory anemia) Myeloproliferative diseases Nasal cavity or sinus or middle ear, primary malignancy Neoplasm of uncertain behavior (i.e. not clear if benign or malignant), NOS Nerves, peripheral or autonomic, primary malignancy Nerves, peripheral, benign neoplasm Non-Hodgkin's lymphoma Ovary, benign neoplasm Ovary, primary malignancy Pancreas, benign neoplasm Pancreas, primary malignancy ... further results

Template:Trauma w mechanism

Infections

Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.

Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site

This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.

Attribution of infections

See Attribution of infections

Template:ICD10 Guideline Combined dx AB resistancee Template:ICD10 Guideline 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.

Combined ICD10 codes

Contents

Coding instructions

Introduction

Clinical Situation Plus its Cause

Primary Admit Diagnosis in Combined Codes

Dxs that can only be expressed as combinations

Questions and concerns

Some specific cases

Malignancy with Metastasis

Infections

Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site

Attribution of infections

Other co-codes

Transition notes

Data

Navigation menu

Combined ICD10 codes

Coding instructions

Introduction

Clinical Situation Plus its Cause

Primary Admit Diagnosis in Combined Codes

Dxs that can only be expressed as combinations

Questions and concerns

Some specific cases

Malignancy with Metastasis

Infections

Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site

Attribution of infections

Other co-codes

Transition notes

Data

Navigation menu

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