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.

Combined coding does not apply to CCI Collection (there is no priority), and there is nothing in the data that links a CCI code to the Dx it is related to.

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

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

Traumas and their Mechanisms

In ICD10, traumas need to be combined with separate mechanism codes to fully explain the situation.

Here are lists of the codes for "mechanical" injuries to various body parts:
- some codes are always traumatic and always need a mechanism:

Trauma codes:
Abdomen or lower back or pelvis NOS, wound/injury/trauma Abdomen or lower back or pelvis, nerves NOS, injury/trauma Abdomen or lower back or pelvis, soft tissues, open wound, injury/trauma Abdomen or lower back or pelvis, superficial injury/trauma (minor, contusion) Abdomen or pelvic, blood vessels NOS, injury/trauma Air embolism, traumatic Ankle or foot or toes, amputation, injury/trauma Ankle or foot or toes, blood vessels, wound/injury/trauma Ankle or foot or toes, fracture, injury/trauma Ankle or foot or toes, joints or ligaments, dislocation/sprain/strain, injury/trauma Ankle or foot or toes, muscles/tendons, wound/injury/trauma Ankle or foot or toes, nerves, wound/injury/trauma Ankle or foot or toes, open wound, injury/trauma Ankle or foot or toes, superficial injury/trauma (minor, contusion) Ankle or foot or toes, wound/injury/trauma, NOS Aorta, abdominal, injury/trauma Aorta, thoracic, injury/trauma Bladder, traumatic laceration/rupture Bladder, wound/injury/trauma Brain injury, diffuse (TBI), injury/trauma Brain injury, focal (TBI), injury/trauma Brain, cerebral edema, injury/trauma Brain, concussion, injury/trauma Brain/intracranial injury NOS, injury/trauma Carotid artery, injury/trauma Clavicle or scapula or humerus, fracture, injury/trauma Colon (large intestine), traumatic laceration/rupture Colon (large intestine), wound/injury trauma Cranial nerve, wound/injury/trauma Ear, foreign body in Eardrum (tympanic membrane), rupture, injury/trauma Elbow or forearm, superficial injury/trauma (minor, contusion) Elbow or forearm, wound/injury/trauma, NOS Elbow, joints or ligaments, dislocation/sprain/strain, injury/trauma Elbow, open wound, injury/trauma Epidural hemorrhage, injury/trauma Esophagus, wound/injury/trauma Eye (globe), wound/injury/trauma Eye, foreign body in Fat embolism, traumatic Femur, fracture, injury/trauma Flail chest, injury/trauma Forearm, amputation, injury/trauma Forearm, blood vessels, wound/injury/trauma Forearm, muscles/tendons, wound/injury/trauma Forearm, nerves, wound/injury/trauma Forearm, open wound, injury/trauma Gallbladder or bile ducts, traumatic laceration/rupture Gallbladder or bile ducts, wound/injury/trauma Gastrointestinal (GI) tract, foreign body in Genitorurinary tract, foreign body in Head NOS, wound/injury/trauma Head bones NOS, fracture, injury/trauma Head, joints or ligaments, dislocation/sprain/strain, injury/trauma Head, open wound, injury/trauma Head, superficial injury/trauma (minor, contusion) Heart, wound/injury/trauma Hemothorax, traumatic Hip or thigh, amputation, injury/trauma Hip or thigh, blood vessels, wound/injury/trauma Hip or thigh, muscles/tendons, wound/injury/trauma Hip or thigh, nerves, wound/injury/trauma Hip or thigh, open wound, injury/trauma Hip or thigh, superficial injury/trauma (minor, contusion) Hip or thigh, wound/injury/trauma, NOS Hip, joints or ligaments, dislocation/sprain/strain, injury/trauma Inferior vena cava (IVC), injury/trauma Intra-abdominal organ NOS, wound/injury/trauma NOS Intracranial hemorrhage, injury/trauma Intrathoracic organ/structure NOS, wound/injury/laceration Kidney, wound/injury/trauma Knee or lower leg, blood vessels, wound/injury/trauma Knee or lower leg, muscles/tendons, wound/injury/trauma Knee or lower leg, open wound, injury/trauma Knee or lower leg, superficial injury/trauma (minor, contusion) Knee or lower leg, wound/injury/trauma, NOS Knee, joint or ligaments or cartilage, dislocation/sprain/strain/tear, injury/trauma Knee, nerves, wound/injury/trauma Liver, wound/injury/trauma Lower leg, amputation, injury/trauma Lower leg, fracture, injury/trauma Lower limb (leg) bones, level not specified/NOS, fracture, injury/trauma Lower limb (leg), level not specified/NOS, amputation, injury/trauma Lower limb (leg), level not specified/NOS, blood vessels, wound/injury/trauma Lower limb (leg), level not specified/NOS, joints or ligaments, dislocation/sprain/strain, injury/trauma Lower limb (leg), level not specified/NOS, muscles/tendons, wound/injury/trauma Lower limb (leg), level not specified/NOS, nerves, wound/injury/trauma Lower limb (leg), level not specified/NOS, open wound, injury trauma Lower limb (leg), level not specified/NOS, superficial injury/trauma (minor, contusion) Lower limb (leg), level not specified/NOS, wound/injury/trauma, NOS Lumbar spine or pelvis, joints or ligaments, dislocation/sprain/strain, injury/trauma Lung NOS, wound/injury/trauma Multiple trauma Muscle, strain Neck structures NOS, wound/injury/trauma Neck, blood vessels NOS, injury/trauma Neck, joints or ligaments, dislocation/sprain/strain, injury/trauma Neck, nerves NOS, injury/trauma Neck, open wound, injury/trauma Neck, superficial injury/trauma (minor, contusion) ... further results

Other codes may or may not be of a traumatic nature; these also qualify to be coded with trauma mechanisms listed below:

Potential trauma codes:
Lightning injury Respiratory tract, foreign body in

Here is a list of the external mechanism or agent that caused the trauma:

Mechanism codes:
Mechanism of injury: animal rider or occupant of animal-drawn vehicle Mechanism of injury: assault with bodily force Mechanism of injury: bus occupant Mechanism of injury: crushed or jammed or pinched in or between objects Mechanism of injury: driver or occupant of ATV or off-road vehicle or snowmobile Mechanism of injury: driver or occupant of watercraft Mechanism of injury: explosion Mechanism of injury: fall or jump (not necessarily from a height) Mechanism of injury: firearm (GSW) Mechanism of injury: hanging or strangulation (accidental or intentional) Mechanism of injury: hypodermic needle Mechanism of injury: knife or other sharp object, stabbing Mechanism of injury: machinery Mechanism of injury: motorcyclist Mechanism of injury: occupant or driver of car or truck Mechanism of injury: other NOS Mechanism of injury: pedal cyclist vs powered vehicle Mechanism of injury: pedal cyclist, not with powered vehicle Mechanism of injury: pedestrian vs powered vehicle Mechanism of injury: pilot or occupant of aircraft Mechanism of injury: struck by an inanimate moving object/blunt trauma Mechanism of injury: train occupant Mechanism of injury: transport or vehicle accident NOS

Regarding Multiple Trauma

When a person has multiple body areas traumatized, code Multiple trauma
When using Multiple trauma also code the individual things traumatized, e.g. leg, arm, head, etc.
Code Multiple trauma and all the individual things traumatized as Combined ICD10 codes
- And in this case, assuming that they all have the same mechanism of injury (e.g. Mechanism of injury: motorcyclist), then you'd also code that Mechanism code as the same Combined ICD10 codes.
If the multiple trauma is the primary admit diagnosis, then among this group of linked ICD10 codes, the Primary Admit Diagnosis would be either the Multiple trauma or the "worst" thing injured, e.g. Brain injury, diffuse (TBI), injury/trauma

Iatrogenic injuries

Some iatrogenic codes are self-explanatory for what occurred. For example Iatrogenic, air embolism, as complication of line/infusion/transfusion/injection. But for others, such as Iatrogenic, puncture or laceration, related to a procedure or surgery NOS it's not clear what happened, i.e. what was iatrogenically injured.
- In these latter cases, with just one exception, DO NOT also code a trauma code for what was iatrogenically injured. This is because iatrogenic injuries are technically not considered to be traumas.
  - that one exception is you should code Rib fracture(s) due to CPR in the context of CPR, cardiac resuscitation.
- Instead, combine the iatrogenic code with another ICD10 code indicating the body part involved.
  - e.g. for iatrogenic laceration of a pulmonary artery, combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS with Disorder of pulmonary vessels, NOS. See list of NOS codes in ICD10.

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

Antibiotic resistance

Antibiotic resistance is coded as Combined ICD10 codes of the condition/pathogen and the resistance. See Antibiotic Resistant Organism for more info.

Antibiotic resistance codes:
Resistance to antimicrobials, antibiotic, resistance to other beta lactams Resistance to antimicrobials, antifungal drug Resistance to antimicrobials, antiparasitic drug Resistance to antimicrobials, antiviral agent Resistance to antimicrobials, classic anti-mycobacterial agent Resistance to antimicrobials, drug NOS Resistance to antimicrobials, extended spectrum beta lactamase (ESBL) Resistance to antimicrobials, methicillin (anti-staph penicillins) Resistance to antimicrobials, miscellaneous antibacterial antibiotics Resistance to antimicrobials, vancomycin Resistance to carbapenem antibiotics

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.

CCMDB Data Integrity Checks

Some codes always need to be combined with one or more others. See Minimum combined codes for details.

Most infection codes require combined-coding of a pathogen (some have it implied, like Mumps), and some disorders can have a pathogen if their cause is infectious. See Bug required for details.

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

Some specific cases

Malignancy with Metastasis

Traumas and their Mechanisms

Regarding Multiple Trauma

Iatrogenic injuries

Infections

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

Attribution of infections

Antibiotic resistance

Other co-codes

CCMDB Data Integrity Checks

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

Some specific cases

Malignancy with Metastasis

Traumas and their Mechanisms

Regarding Multiple Trauma

Iatrogenic injuries

Infections

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

Attribution of infections

Antibiotic resistance

Other co-codes

CCMDB Data Integrity Checks

Transition notes

Data

Navigation menu

Search