Admit Diagnosis
For other diagnoses, see Comorbid Diagnosis and Acquired Diagnosis / Complication.
Admit diagnoses are what led to the start of the patient's current PatientFollow Project profile. An Admit Diagnosis is coded by setting the Dx_Type to "admit". We make special use of the Primary Admit Diagnosis, so make sure you consider the content there.
Collection Instructions
When to use Comorbid Diagnosis vs Admit Diagnosis or neither
When not to code a dx at all
- Dx was present in the past but that problem is resolved AND does not fit into one of the Category: Past medical history codes
- To be clear on this -- do NOT code past problems that are fully resolved unless they are one of the Category: Past medical history codes
- Do not code diagnoses that occur during this admission as a comorbid diagnoses. If they have completely resolved then do not code as a comorbid diagnosis until the next admission if applicable. ie. surgical ward had a COVID pneumonia resolved prior to ICU admission. Do not code Past history of Covid-19 infection until the next hospital admission.
Regular comorbid rules exception: Strokes (of any sort, ischemic or hemorrhagic) -- code even resolved strokes with no current sequelae as comorbid diagnoses. If a patient has a past history of stroke, use the regular stroke codes to identify this, even if the patient does not have any residual deficits we will now capture ANY past history of stroke. This is contrary to the usual rules about Comorbid_Diagnosis#When_not_to_code_a_dx_at_all.
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Some diagnoses can/should be coded as BOTH Admit Diagnosis and Comorbid Diagnosis
If a dx is chronic but also actively treated during this admission, code it as both Admit Diagnosis and Comorbid Diagnosis.
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Recurrent conditions
- Do not code a recurrent condition that is NOT currently present -- if currently active, include as Admit Diagnosis, otherwise don't code it
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- Do code conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.
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Past medical history
Past medical history codes
Past medical history codes should only be captured as Comorbid Diagnoses that represent previous procedures or medical situations. Their names usually follow the pattern "Past history of X" or "X, has one". See Category:Past medical history for a list.
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.
Legacy - did not use to code Comorbid Diagnoses only discovered during this admission
see how this used to be coded... |
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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.
- There are sometimes subtle issues here, especially for diagnoses that use lab test results.
- An example is patient comes in to ED with shock presumed due to pneumonia and a lactate=1.7 --> this doesn't meet the requirement for Shock, septic, but by 3 hours later the next lactate checked in the ICU is 2.7, so that threshold for septic shock IS met. Clearly this person was "brewing" septic shock at admission and it seems logical to include that diagnosis as an admit diagnosis. THUS -- in such cases where it seems pretty clear, in retrospect, that a diagnosis was brewing/present at admission but only became fully evident after admission, that diagnosis SHOULD be coded as an Admit Diagnosis IF it becomes fully evident within 6 hours of admission.
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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.
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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.
Data Structure
Admit Diagnoses are drawn from S_ICD10 table and stored in L_ICD10 table.
Legacy Information
Maximum Number of Admit Diagnoses |
Until we started to use Centralized data.mdb we were limited to 6 admit diagnoses. For some time CCMDB.accdb had been able to record any number of admit diagnoses. However, only the six (6) with the highest priority were appended to TMSX. |
Data Integrity Checks (automatic list)
App | Status | |
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Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTm | CCMDB.accdb | declined |
Query check ICD10 duplicates | CCMDB.accdb | declined |
Controlling Dx Type for ICD10 codes | CCMDB.accdb | declined |
Query check dx primary not exactly one | CCMDB.accdb | implemented |
Query check ICD10 date | CCMDB.accdb | implemented |
Query check VAP admit must be from ICU | CCMDB.accdb | retired |
Query cardiac arrest throughout admission | Centralized data front end.accdb | needs review |