Template:ICD10 Guideline Como vs Admit

This template is used in Comorbid Diagnosis and Admit Diagnosis to give consistent instructions when to use either or neither.

To use:

{{ICD10 Guideline Como vs Admit}}

Dx was present in the past but is not relevant to current admission
- including earlier on during a long admission - if resolved, don't code

Examples
Patient had appendix removed 7 years ago and is now admitted with injuries from a car accident; don't code the appendix removal at all.

Example to code
Patient admitted with a CAP to ICU who was intubated, ventilated and placed on antibiotics. They develop Atrial fibrillation and/or atrial flutter and are placed on meds which may need adjusting because they are still having breakthrough rapid Afib. Once extubated they are often ready for the medicine ward but are still on antibiotics for their CAP and require watching to see if their Afib returns. The medicine collector would list both CAP and Afib as part of their admitting diagnoses.

Example not to code
Patient with BPH who is not on any medications for it. They still have BPH but it is not an active problem being treated.

Dx does not qualify as an Admit Diagnosis and is chronic and was present prior to admission
- 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).

Examples
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. 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.

Do not code recurrent acute conditions that resolve between recurrences; for these, if currently active, include as Admit Diagnosis, otherwise don't code them.

Example of recurrent Dxs not to code
Recurrent pneumonia -- although one can be left with chronic sequelae of pneumonia (e.g. a pneumatocele or a region of emphysema or a bulla), in between these infections, there IS NO pneumonia Recurrent severe sepsis -- same as above

Do code conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.

Example of ongoing Dxs with recurrent episodes that should be coded
Asthma, without acute exacerbation -- this 'is a chronic disease whose nature is intermittent symptoms, but in between those symptoms the person still has asthma. COPD, without exacerbation

So, for chronic conditions that are at their baseline at admission, code those in this bin -- e.g. COPD.
- This "baseline" could include either of: not currently getting any treatment; getting maintenance/control treatment.
- Obviously, if the chronic condition (e.g. COPD) is in exacerbation at admission, then it should be listed under the bin Admit Diagnosis -- e.g COPD, acute exacerbation

There is, in ICD10, a small list of codes that represent previous procedures or medical situations that can't be captured in another way.

Past medical history codes:
Artificial opening NOS, has one Cardiac pacemaker or defibrillator, has one Gastrostomy, has one Heart assist device, has one Past history of Chimeric Antigen Receptor T-cell Immunotherapy (CAR-T) Past history of chemotherapy for neoplastic disease Past history of immunosuppressive drugs or corticosteroids Past history of radiation therapy Past history, bone marrow or stem cell transplant Past history, cancer (any type), believed cured Past history, coronary revascularization Past history, heart valve replacement (any valve) Past history, loss of limb(s) Past history, myocardial infarction (old MI) Past history, organ/tissue transplant NOS Past history, removal of all or part of lung Past history, removal of any part of digestive tract Past history, removal of breast (mastectomy) Past history, removal of kidney (nephrectomy, partial or total) Past history, removal of organ NOS Past history, self-harm, suicide attempt Past history, thromboembolic disease (DVT or PE), now gone Past history, transplanted heart Past history, transplanted kidney Past history, transplanted liver Past history, transplanted lung(s) Past history, transplanted pancreas or islet cells Past history, tuberculosis, believed cured or inactive Suprapubic catheter, indwelling, has one Tracheostomy, has one

An issue in coding chronic comorbid conditions is that in addition to the "usual" ICD10 diagnoses of conditions that could be listed there, ICD10 has a bunch of codes that indicate explicitly either "Past history of X" or "Artifical opening, has one". These are included in here:

Past history codes:

Example of past history
an old, presumably cured, cancer

Some ICD10 codes on the ICD10 Diagnosis List should never, or only ever, be a certain Dx Type. See Controlling Dx Type for ICD10 codes for a discussion about cross-checks for these.

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