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 '' | *'''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 | An [[Acquired Diagnosis]] / Complication is coded by setting the [[Dx_Type]] to "acquired". | ||
Acquired diagnoses | *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. ''' | |||
{{ICD10 Guideline Admit vs Acquired}} | |||
{{DiscussTask | this relates to [[Attribution of infections]] and we need to be sure to have it consistent. }} | |||
{{ | |||
== | == 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]] | |||
===Related articles === | |||
{{Related Articles}} | |||
[[Category: | [[Category: ICD10]] | ||
[[Category: Data Collection Guide]] | [[Category: Data Collection Guide]] | ||
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
- Distinction between Admit Diagnoses and Acquired Diagnoses relates 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 Diagnoses.
Example: |
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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.
- 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.
Examples 1 and 2 |
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- 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.
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.
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- 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. |
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.