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

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 it's just a matter of ensuring that the multiple codes are all in the diagnosis list.
For other situations the multiple codes need to be linked together (we use the term "combined").
For some entities there is no single ICD10 code, and the only way to code that entity is to combine two codes. An example is that to identify Retroperitoneal hemorrhage one must link two codes Hemorrhage, NOS and Retroperitoneal area, diagnostic imaging, abnormal. So, alongside each of those is a message about this.

Malignancy with Metastasis

Here, code BOTH the primary site and the location(s) of mets -- and these need to be combined because the codes for mets don't specify the primary site, only the site of the mets.
There are codes for mets to the following places:

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)

Infections, Antibiotic Resistance

There are some single infection codes that incorporate the organism in the name, e.g: Salmonella enteritis
But for most infections, they don't, e.g: Pneumonia, bacterial
In these cases it is required to combine with the infection code the code for the organism from the "buglist":

Pathogens codes:
Acinetobacter species Adenovirus Aspergillus Bacillus fragilis (B. frag) Bacteria, NOS Blastomyces COVID-19 (SARS-COV-2) Candida species Chlamydia trachomatis (bug responsible for regular sexually transmitted chlamydia) Citrobacter species Clostridium perfringens Coccidioides Coronavirus Cryptococcus Cytomegalovirus (CMV) Entamoeba histolytica (amoebic infection of non-intestinal sites) Enterobacter species Enterococcus species Enterovirus - incl coxsackievirus, echovirus Escherichia coli (E. coli) Fungus or yeast, NOS Haemophilus influenzae (H. flu) Helicobacter pylori (H. pylori) Herpes simplex virus (HSV) Histoplasma Infectious organism, unknown Influenza virus NOS -- should almost never be used Klebsiella species Legionella Listeria Lyme disease OR for buglist Borrelia burgdorferi or B. mayonii Measles virus Mosquito-borne viruses (causes of encephalitis) Mucormycetes Mumps virus Mycobacterium avium-intracellulare (MAC) Mycobacterium tuberculosis (M. TB) Mycoplasma pneumoniae Neisseria gonorrhea (gonococcus) Neisseria meningitidis (meningococcus) Nocardia (nocardiosis) Nontuberculous mycobacteria Other type of infectious organism, NOS Papillomavirus Paracoccidioides Parainfluenza virus Parvovirus Pneumocystis Jirovecii or Pneumocystis Carinii Proteus mirabilus (morganii) Protozoa, NOS Pseudomonas Rabies OR for buglist rabies virus Reovirus Respiratory syncytial virus (RSV) Retrovirus Rubella virus (German measles virus) Salmonella species Serratia species Spirochetes, NOS - incl yaws, louse-borne, tick-borne Sporothrix Staphylococcus aureus Staphylococcus, NOS Stenotrophomonas species Streptococcus group A (strep pyogenes) Streptococcus group B (strep agalactiae) Streptococcus group D Streptococcus group G Streptococcus pneumoniae Streptococcus, NOS Tick-borne viruses (causes of encephalitis) Toxoplasmosis OR for buglist Toxoplama gondii Treponema pallidum (Syphilis) Varicella zoster virus (VZV) Virus, NOS West Nile virus

This buglist contains specific codes for a number of different bacteria, viruses, fungi/yeast, mycobacteria and miscellaneous types of organisms.
- If you don't see the specific organism in your case, then there are wastebasket codes:
  - Bacteria, NOS
  - Virus, NOS
  - Fungus or yeast, NOS
  - Nontuberculous mycobacteria
  - and finally when you don't have any idea even what type of bug it is: Infectious disease NOS OR for buglist organism NOS

NEXT, if the bug is resistant to antimicrobials, the infection/bug combination should be further combined with a code for antibiotic resistance -- thus in this situation all 3 codes will be combined together.

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

Trauma with mechanism

Template:Trauma w mechanism

Fractures

see also Coding fractures in ICD10 Template:Discussion not yet integrated...

Other co-codes?

Template:Discussion Are there others? What are they?

NOT YET FIGURED OUT

General instruction when to code together

Template:Discuss@task

Primary Diagnosis within Combined Codes

Template:Discuss@task

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.