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
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Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review |
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
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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.
Example: |
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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.
- Ex2: Asthma, without acute exacerbation -- this 'is a chronic disease whose nature is intermittent symptoms, but in between those symptoms the person still has asthma.}}
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 that can't be captured in another way. 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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Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review |
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.
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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 ward 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 arrythmia) has no role in decision-making about how these diagnoses are listed (or not)
Example: |
testcontent |
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 (SMW)
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 date | CCMDB.accdb | implemented |
Query check dx primary not exactly one | CCMDB.accdb | implemented |
Query check VAP admit must be from ICU | CCMDB.accdb | retired |