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.
For some entities there is no single ICD10 code, and the only way to code the 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.
- Another example is coding Hospital-acquired pneumonia. To get this you combine Iatrogenic, complication of medical or surgical care NOS with the appropriate type of pneumonia code, e.g. Pneumonia, bacterial or Pneumonia, fungal/yeast

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 (upper GI bleed/hemorrhage), NOS
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.

Combined Codes when coding the Primary Admit Diagnosis

Sometimes an entity best represented as a combined code will be the Primary Admit Diagnosis. The way we use these means we don't want a patient to have two. Normal combined coding would lead to two diagnoses with the highest priority so we have to make a choice.

The solution is to do BOTH of the following:

For the #1, main reason for admission diagnosis, choose as #1 the diagnosis associated with the highest mortality, i.e. the one that’s “worst”. For example, for Liver failure due to Hep B, you'd usually choose the Liver failure as #1.
ALSO separately code them together, i.e. combined. Yes, there's then some duplication in the diagnosis code list (in the example you'd code Liver failure as the #1 diagnosis, and also code the Liver failure combined with Hep B), but that's OK.

This solution also works for the rare entities which can only be coded with a combination of two codes. The example above of retroperitoneal hemorrhage is a good one if it's the #1 reason for admission. Here you'd code the Hemorrhage, NOS as #1, but ALSO code Hemorrhage, NOS combined with Retroperitoneal area, diagnostic imaging, abnormal

different way to deal with Primary Dx in ICD10 codes

Template:Discussion Template:ICD10

Double coding like that will be a bit of a nuisance, and it will also make counting dxs etc harder since sometimes codes with priority 1 will need to be excluded. If we added a column "primary" to the L_ICD10 table, and required a single check and no more for each patient, I think that would be easier for coding and easier for entering. Julie, would that work for you? Ttenbergen 14:29, 2017 November 26 (CST)

Some specific cases

Template:Combined dx metastasis primary Template:Combined dx AB resistance Template:Trauma w mechanism 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.

Combined ICD10 codes

Contents

Coding instructions

Introduction

Clinical Situation Plus its Cause

Combined Codes when coding the Primary Admit Diagnosis

different way to deal with Primary Dx in ICD10 codes

Some specific cases

Other co-codes

Transition notes

Data

Navigation menu

Combined ICD10 codes

Coding instructions

Introduction

Clinical Situation Plus its Cause

Combined Codes when coding the Primary Admit Diagnosis

different way to deal with Primary Dx in ICD10 codes

Some specific cases

Other co-codes

Transition notes

Data

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