Acquired Diagnosis / Complication: Difference between revisions

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


'''Acquired Diagnoses''', also referred to as '''complications''', are ''the most significant'' problems, surgical procedures or diagnostic procedures that happen to a patient '''AFTER''' unit admission.  
*'''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).


Acquired diagnoses are coded "in order of occurrence" on a ward/unit.
An [[Acquired Diagnosis]] / Complication is coded by setting the [[Dx_Type]] to "acquired".  


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 ward with the problem in the first place but it took a few days to figure that out. 
*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. '''


==[[Significant complications medicine]]==
{{ICD10 Guideline Admit vs Acquired}}
For a list of the complications that are a '''priority''' which are looking for go to: [[Significant complications medicine]]


We don't repeat the diagnosis in the acquired section.For example if the admit diagnosis is CHF they get treated but relapse back into CHF we do not add that as a acqiured complication.
{{DiscussTask | this relates to [[Attribution of infections]] and we need to be sure to have it consistent. }}


For procedures we can repeat them once as a complication. For example if the patient came in with a scope in the admit and then had 3 more scopes in the hospital you would enter it''' once''' as an acquired.Another example skin grafting enter it once.
== 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.


==[[Significant complications ICU]]==
==Data Structure==
For a list of the complications that are a '''priority''' which we are looking for go to:[[Significant complications ICU]]
Acquired Diagnoses are drawn from [[S_ICD10 table]] and stored in [[L_ICD10 table]].


== Maximum Number of Acquired Diagnoses ==
== Cross checks ==
The PDA and the CCMDB.mdb can record as many acquired diagnoses as you want as you go along. However, only the '''nine (9)''' with the highest priority will be appended to [[TMSX]].
* [[Query check ICD10 date]]
Since acquired diagnoses are prioritized by order of occurrence, this means that you might want to re-prioritize or delete more minor acquireds if keeping them would mean that a more major acquired diagnosis would not be within the 9 highest priorities, and therefore would not be sent. See [[Significant complications medicine]]  &  [[Significant complications ICU]] to guide you in this judgement.


== loosing info for long-term patients==
===Related articles ===
{{discussion}}
{{Related Articles}}
*As our ICU's have more and more [[LTV]] patients that are essentially a hospital hold for IICU, Riverview etc this section will have to be re-vamped...ex:  I have a pt that will soon have been in the ICU for a year.  We are losing points and information about this patient as we are only counted for the top "9" with the highest priority.  In my case I am deleteing numerous high priority complications because of this...so in the end... what is collected is not indicative of that patient at all????--[[User:Wturner|Wturner]] 13:15, 7 February 2010 (CST)
** Trish, I think the way I cleaned up the main section of this article means that the max # of points possible will be collected. This would mean that Wendy's concern is addressed, correct? If you agree, please remove this section. [[User:Ttenbergen|Ttenbergen]] 16:58, 2 November 2010 (CDT)
***I don't know what you mean by point for complications?--[[User:TOstryzniuk|TOstryzniuk]] 17:32, 3 November 2010 (CDT)
**** I meant that, with the changes I had made to the instructions, the most important complications would be the ones that would stay. Specifically, that as you run out of spots you delete the ones that are not as important so that we get the most importand complications within the limited number of spots available, rather than the original instructions to be entirely chronological. This still isn't a good way to do this; one way to fix would be to wait for the new repository with unlimited # of complications, another would be to add a column to prioritize s_alldxs into groups of prioirties for the dx (vs priorities for the ''collected'' dx), so that I could sort the list first by priority and then chronologically (would not work if we use the fact that the list is currently chronological for anything). This is a bit of a messy explanation, call if you want to talk about it.[[User:Ttenbergen|Ttenbergen]] 09:56, 4 November 2010 (CDT)


== should it be "acquired diagnoses" or "complications"? ==
[[Category: ICD10]]
{{discussion}}
right now different terms are used in different places. EG CCMDB uses acquired, this article is acquired, I don't know what TMSX uses, but the category name is "complications". Can we settle on one? I am volunteering to clean this up on the wiki if we settle on one. [[User:Ttenbergen|Ttenbergen]] 16:58, 2 November 2010 (CDT)
**both terms are used to refer to problems, procedures, surgery that occur "AFTER" the patient is admitted to a unit.--[[User:TOstryzniuk|TOstryzniuk]] 17:31, 3 November 2010 (CDT)
 
===Data Structure===
Acquired Diagnoses are drawn from [[S_AllDiagnoses]] and stored in [[L_Dxs]] on the PDA and in the [[CCMDB.mdb]].
 
 
 
[[Category: Complications | * ]]
[[Category: Diagnosis Coding | *]]
[[Category: Data Collection Guide]]
[[Category: Data Collection Guide]]
[[Category: Questions_Diagnosis]]

Revision as of 12:05, 2021 April 1

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.


When to code an Admit Diagnosis vs 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.

Onset not discovery

Code diagnoses are based on the onset of the condition, not necessarily when it was discovered. If a diagnosis is discovered after admission, but likely was present on admission (example, diabetes mellitus) then code it appropriately as a Comorbid Diagnosis or an Admit Diagnosis if it was related to the reason for admission.

Example:   

Patient is admitted with what was thought to be a COPD exacerbation. A few days after admission, they decide the likely cause for this respiratory failure was actually pneumonia, and during these diagnostic tests, discover that the patient has an abdominal aorta aneurysm. In retrospect, it is clear that the pneumonia was the cause of the admission, so the Admit Diagnosis will be pneumonia not COPD exacerbation. The abdominal aorta aneurysm would have had to exist prior to admission, but is not relevant to why the patient is in hospital, and therefore should be coded as a Comorbid Diagnosis.

Diagnosis categories in relation to patients moving around the hospital

  • This section explains how to determine the Dx Type 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 location A (ward) to location B (ICU) to location C (ward), which would constitute three separate patient profiles.
  • Rule#1: Situation where a diagnosis is new to this hospitalization, do not code as a Comorbid Diagnosis. Comorbid diagnoses need to be a chronic, pre-existing disorder that existed prior to the patient’s initial hospitalization, regardless of their physical location throughout this stay.
    • Therefore, any new diagnosis that occur in location A, should not be coded as a comorbid diagnoses for the profiles for location B or location C.
      • 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. It will be captured in the data from the initial location.
      • 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.
Examples 1 and 2   
  • Example 1: Patient is admitted to location A with pneumonia, then transfers to location B for worsening of the pneumonia, then improves and transfers to location C but remains on antibiotics. This encapsulates three separate database profiles, and pneumonia will be the Admit Diagnosis for all three profiles.
  • Example 2: Patient is admitted to location A with pneumonia, then transfers to location B for worsening of the pneumonia. In location B, the pneumonia resolves and the course of antibiotics is finished. The patient is then transferred to location C for continued rehab for muscle wasting after the critical illness. Pneumonia would then be the admit diagnosis for location A and location B, but will not be captured on location C. The admit diagnosis for location C would be Muscle, wasting/atrophy NOS. Muscle, wasting/atrophy NOS would be captured as an Acquired Diagnosis in location B.
  • Rule#2: The group of diagnoses that represent "past history" (e.g. Past history, loss of limb(s)) are also guided by Rule#1. Comorbid diagnosis must have been a chronic, pre-existing disorder that existed before the hospital admission.
Examples 3 and 4   

Example 3: Patient is admitted to location A for osteomyelitis. During this stay, the patient experiences a cardiac arrest and is transferred to location B. In location B, the leg is amputated as source control and the course of antibiotics is finished. There are no further cardiac arrhythmias and patient is no longer on any anti-arrhythmic medication. They are then transferred to location C.

  • Osteomyelitis would be the admit diagnosis for location A, and an admit diagnosis for location B. It would not be captured as a diagnosis for location C as it is resolved.
  • Cardiac arrest would be the acquired diagnosis for location A, the primary admit diagnosis for location B, and would not be captured as a diagnosis for location C.
  • At no point is Past history, loss of limb(s) captured as it was not a chronic, pre-existing disorder prior to the overall hospital admission.

Example 4: Patient is admitted to location A for osteomyelitis. During this stay, the patient experiences a cardiac arrest and transfers to location B. In location B, the leg is amputated as source control and the course of antibiotics is finished. There are no further cardiac arrhythmias, but the patient remains on anti-arrhythmic medication. They are then transferred to location C.

  • Osteomyelitis would be the admit diagnosis for location A, and an admit diagnosis for location B. It would not be captured as a diagnosis for location C as it is resolved.
  • Cardiac arrest would the acquired diagnosis for location A, the primary admit diagnosis for location B. As the cardiac arrhythmia is still being treated, an admit diagnosis for location C would be cardiac arrhythmia, NOS.
  • At no point is Past history, loss of limb(s) captured as it was not a chronic, pre-existing disorder prior to the overall hospital admission.
  • Rule#3: 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.

Attribution of infections

Attribution of infections provides more info on when to code infections as what Dx Type.

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.

  • SMW


  • Cargo


  • Categories

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

Related articles

Related articles: