Acquired Diagnosis / Complication

For other types of diagnoses, see Admit Diagnosis and Comorbid Diagnosis.

• Acquired Diagnoses, also referred to as complications, are problems or procedures that occur AFTER a patient has been accepted to a physician service ICU or Medicine regardless of physical location and has an Service tmp entry dttm. (While in ER collection starts at Accept DtTm).

An Acquired Diagnosis / Complication is coded by setting the Dx_Type to "acquired".

• Acquired diagnoses are prioritized (Dx Priority field) in order of occurrence.
• Coding for Acquireds/complications follows the general ICD10 collection instructions.
• The Dx_Date is mandatory for Acquireds/complications.

Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review

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When to code an Admit Diagnosis vs Acquired Diagnosis

• Distinction between Admit Diagnoses and Acquired Diagnoses relate to the start of a PatientFollow Project profile. An Admit Diagnosis needs to be present at the start of a PatientFollow Project profile. Diagnoses that occur after will be Acquired Diagnosis.

Example:

Example1 -- patient's care is taken over by Medicine service while he is still in ED. The admission diagnosis is DKA. He remains on Medicine service in ED (due to lack of ward beds) for 2 days, after which he finally gets up to the Medicine ward and then has a stroke. The stroke is an Acquired Diagnosis, and would still be acquired even if it had occurred during those 2 days in ED. AND Dx is relevant to this admission in that it is either: (a) an acute or exacerbated condition (as opposed to a chronic, stable condition -- e.g. stable diabetes), OR (b) it is a condition not directly related to the reason(s) for admission, but its treatment is being actively managed -- and by actively we mean that during this admission changes are made to the management. Example2: Patient with TB has been treated for the past 5 (of his 9 expected) months admitted now for acute MI. Scenario#1:No changes made in his TB treatment ---> so NOT an Admit Diagnosis (but this active TB is a Comorbid Diagnosis ) Scenario#2:Changes are made to his TB treatment during this admission ---> so IS an Admit Diagnosis too

Onset not discovery

Acquired diagnoses do not refer to diagnoses that have been discovered after the patient comes to the unit if it is likely that the patient was admitted to current/Boarding Location with the problem in the first place but it took a few days to figure that out. Code these as Comorbid Diagnosis, and also, if appropriate (i.e. it was related to the reason for admission) as a Admit Diagnosis.

Diagnosis categories in relation to patients moving around the hospital

• This section explains how to determine the Dx Types as a patient moves from place to place within a hospital -- i.e. during a single hospitalization. In this section we'll refer to a person who moves from A to B to C (e.g. A and C are ICU while B is ward; so 3 separate records in the database)
• Rule#1: Situation where a diagnosis is NEW to this hospitalization [i.e. either it: (a) was an Admit Diagnosis to location A that was not a chronic, pre-existing disorder before hospitalization, OR (b) developed after admission, as an acquired diagnosis while in location A], then:
  • when you start records B or C do NOT include that diagnosis as a comorbid
  • if by the time they are transferred to the subsequent location it is resolved and no longer being treated, then it should not show up as any kind of diagnosis for that subsequent record
  • if by the time they are transferred to the subsequent location it is still being dealt with medically, and indeed is part of the reasons they are going to the new location, then it should be listed as an Admit Diagnosis for that subsequent record
• Rule#2: The group of diagnoses that represent "past history" (e.g. Past history, loss of limb(s) are also guided by Rule#1.
• Rule#3: The "duration" of a diagnostic event (e.g. pneumonia vs. an arrhythmia) has no role in decision-making about how these diagnoses are listed (or not)

Rules 1 and 2 are clear, could rule 3 be further clarified

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Example:

Example1: Admitted to A=ward for pneumonia --> gets worse sent to B=ICU --> improves sent back to C=ward but still on antibiotics for the pneumonia. So, 3 distinct database records. Pneumonia is Admit Diagnosis for A; Admit Diagnosis for B; Admit Diagnosis for C. Example2: Admitted to A=ward for pneumonia --> gets worse sent to B=ICU where the patient improves and is off antibiotics --> improves sent back to C=ward off the antibiotics. So, 3 distinct database records. Pneumonia is Admit Diagnosis for A; Admit Diagnosis for B; not listed at all for diagnoses for C. Example3: Admitted to A=ward for osteomyelitis --> arrests in A and sent to B=ICU --> while in B the leg gets amputated and the patient finishes up his course of antibiotics so the osteo is now resolved; there have been no further arrhythmias and the patient is not on any anti-arrhythmics --> improves and goes to C=ward. So, 3 distinct database records. The osteomyelitis is Admit Diagnosis for A; Admit Diagnosis for B; not listed as any diagnosis for C since it's resolved and no longer being treated The cardiac arrest is Acquired Diagnosis for A; Admit Diagnosis for B; not listed as any diagnosis for C Example4: Admitted to A=ward for osteomyelitis --> arrests in A and sent to B=ICU --> while in B the leg gets amputated and the patient finishes up his course of antibiotics so the osteo is now resolved; there have been no further arrhythmiabut the patient remains on antiarrhythmic therapy --> improves and goes to C=ward still on the antiarrhythmics. So, 3 distinct database records. The osteomyelitis is Admit Diagnosis for A; Admit Diagnosis for B; not listed as any diagnosis for C since it's resolved and no longer being treated Do not list Past history, loss of limb(s) for record C since it happened this same hospitalization. The cardiac arrest is acquired diagnosis for A; Admit Diagnosis for B; not listed as any diagnosis for C but as he is still on antiarrhythmics so as an Admit Diagnosis for C list Cardiac arrhythmia, NOS Rule#4: This is really an observation rather than a "rule". We recognize and accept that the above rules and examples can lead to a single diagnostic event seeming to occur multiple times, while in fact it only occurred once. In Example2, since the pneumonia is listed as an Admit Diagnosis for records A and B and C, it won't be possible to distinguish whether these were a single, ongoing pneumonia versus an original pneumonia plus subsequent separate pneumonia events. The underlying reason for this is the artificial nature of how we collect data -- i.e. when a person goes A-->B-->C this is a single hospital episode but we code it as 3 different records.

Legacy - prior to PatientFollow Project

expand for pre-PatientFollow Project info

Prior to PatientFollow Project there was one record per ward/unit stay, so the distinction between Admit Diagnosis and Acquired Diagnosis would have been made on a per-unit basis; since then it is made on a per-PatientFollow Project profile basis.

Controlling Dx Type for ICD10 codes

This wiki page talks about which ICD10 codes are allowed to be Comorbid Diagnosis vs. Admit Diagnosis vs. Acquired Diagnosis Dx Type. See Controlling Dx Type for ICD10 codes for a discussion about cross-checks for these.

this relates to Attribution of infections and we need to be sure to have it consistent.

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Repeating Complications

• In general things that occur, fully resolve, and then recur SHOULD be coded each time they recur.
  • e.g. postop hemorrhage --> goes to OR to have it fixed --> IS fixed ---> 3 days later has more postop hemorrhage
• For things that happen multiple times, some we WANT to list multiply and others we only list once
  • The ones we only list once include that info: Template:ICD10 Guideline repeated events. These are generally signs/symptoms, and arrythmias.
  • Otherwise, DO list it multiply --- e.g. after admit has a stroke --> 4 days later has a NEW/DIFFERENT stroke.

Data Structure

Acquired Diagnoses are drawn from S_ICD10 table and stored in L_ICD10 table.

Cross checks

• Query check ICD10 date