For other diagnoses, see Comorbid Diagnosis and Acquired Diagnosis / Complication.
Admit diagnoses are what led to the patient's admission to your unit. 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.
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 vs Admit Diagnosis or neither
When not to code a dx at all
- Patient had the left lung removed 7 years ago. Code Past history, removal of all or part of lung
- Patient has hypertension for which she takes medications and it is well controlled, but not related to the reasons for admission. Code this, because even if not part of the reason for the current admission, the hypertension IS relevant to this person's chronic medical situation and thus SHOULD be coded, as a comorbid.
- Patient had ARDS (noncardiogenic pulmonary edema) a few years ago, and while ARDS is only an acute problem and thus is no longer active, his lungs never fully recovered and he has Respiratory failure (insufficiency), chronic which should be coded as a comorbid.
- Chronic and ongoing old conditions should be coded -- as a comorbid if not part of the reason for this admission.
- Dx was present prior to physical arrival in their bed on unit/ward
- 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.
- 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 dx.
- Scenario#2:Changes are made to his TB treatment during this admission ---> so IS an admit dx too
- Dx is chronic and at its baseline situation, and was present prior to admission
- Dx is in the past and is resolved and is included in one of the: Category: Past medical history codes
- Code these even if the diagnosis of the condition was only made during the current hospital admission but it is quite clear that it must have existed before admission (even if that wasn't known). Here are some examples of that situation:
- If a patient is admitted with pneumonia and on further workup is found to have CA of the lung, then this is coded in comorbid as it is obvious that the cancer must have been there for a while prior to admission.
- Patient comes in with abdominal pain. Diagnosed as gastroenteritis but incidentally pt is found to be HIV +ve. You would code HIV +ve as a comorbid. Again, this is obvious that the pt had this problem for a while prior to admission to the hospital.
Some diagnoses can/should be coded as BOTH admit and comorbid
- example: Patient who has been, and still is, being treated for active pulmonary TB as an outpatient, and is admitted for an acute MI. Here since on the current admission the TB is still being actively treated, it qualifies as an admit diagnosis, as above. But because it has been present from long before this admission, it also qualifies as an "active" comorbidity.
- example: Patient has a past history of CHF and thus it should be coded as a comorbid. And if the CHF is worse at admission and it is part of the reason for admission, then CHF should also be an admit code too.
- Do not code a recurrent condition that is NOT currently present -- if currently active, include as Admit Diagnosis, otherwise don't code it
- Recurrent pneumonia -- in between the infections, there IS NO pneumonia
- Do code conditions that by nature have intermittent rather than continuous symptoms, but where the underlying condition doesn't go away.
Past medical history
Category:Past medical history contains codes that should only be captured as Comorbid Diagnosis 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 "Artifical opening, has one".
|Past medical history codes:
- Artificial opening NOS, has one
- Cardiac pacemaker or defibrillator, has one
- Gastrostomy, has one
- Heart assist device, has one
- Past history of Chimeric Antigen Receptor T-cell Immunotherapy (CAR-T)
- Past history of chemotherapy for neoplastic disease
- Past history of immunosuppressive drugs or corticosteroids
- Past history of radiation therapy
- Past history, bone marrow or stem cell transplant
- Past history, cancer (any type), believed cured
- Past history, coronary revascularization
- Past history, heart valve replacement (any valve)
- Past history, loss of limb(s)
- Past history, myocardial infarction (old MI)
- Past history, organ/tissue transplant NOS
- Past history, removal of all or part of lung
- Past history, removal of any part of digestive tract
- Past history, removal of breast (mastectomy)
- Past history, removal of kidney (nephrectomy, partial or total)
- Past history, removal of organ NOS
- Past history, self-harm, suicide attempt
- Past history, thromboembolic disease (DVT or PE), now gone
- Past history, transplanted heart
- Past history, transplanted kidney
- Past history, transplanted liver
- Past history, transplanted lung(s)
- Past history, transplanted pancreas or islet cells
- Past history, tuberculosis, believed cured or inactive
- Suprapubic catheter, indwelling, has one
- Tracheostomy, has one
This wiki page talks about which ICD10 codes are allowed to be Comorbid vs. Acute vs. Acquired diagnosis type. See Controlling Dx Type for ICD10 codes for a discussion about cross-checks for these.
Admit Diagnoses are drawn from S_ICD10 table and stored in L_ICD10 table.
|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.
- User:Ttenbergen (← links)
- Palliative care (← links)
- Acquired Diagnosis / Complication (← links)
- Hypertension (← links)
- Comorbid Diagnosis (← links)
- General Diagnosis Coding Guidelines (← links)
- Staphylococcus aureus (← links)
- Check CRF vs ARF across multiple encounters (← links)
- Check BRR/XBR vs cardiac arrest dx (← links)
- Primary Admit Diagnosis (← links)
- Auto Data Dictionary (← links)
- Task Team Meeting - Rolling Agenda and Minutes 2018 (← links)
- Pacemaker insertion (TISS Item) (← links)
- L ICD10 table (← links)
- ICD10 collection (← links)
- Dx Date (← links)
- Dx Type (← links)
- Dx Priority (← links)
- Hallucinogen, acute intoxication (← links)
- Acute myocardial infarction complication of Dressler's syndrome (postmyocardial infarction syndrome) (← links)
- Obesity-hypoventilation syndrome (Pickwick syndrome) (← links)
- Alcohol (ethanol) acute intoxication (drunkenness) (← links)
- Opioid/narcotic, acute intoxication (← links)
- Sedative or hypnotic, acute intoxication (← links)
- Cocaine, acute intoxication (← links)
- Solvent (organic, inhaled or ingested), intoxication, acute (← links)
- Psychoactive substance NOS, acute intoxication (← links)
- Depression (major depressive disorder, recurrent depression) (← links)
- Epilepsy, or seizure in patient with known epilepsy, any type incl myoclonic (← links)
- Myocardial infarction, acute (AMI), transmural (Q-wave) (← links)
- Myocardial infarction, acute (AMI), subendocardial/non-transmural (non-Q-wave) (← links)
- Myocardial infarction, acute (AMI), NOS (← links)
- Past history, myocardial infarction (old MI) (← links)
- Pneumonia, ventilator-associated (VAP) (← links)
- Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 (← links)
- Iatrogenic, infection, related to vascular access other than central line (← links)
- Iatrogenic, infection, following a procedure or surgery, NOS (← links)
- Iatrogenic, infection, heart valve prosthesis (incl prosthetic valve endocarditis) (← links)
- Iatrogenic, infection, cardiac or vascular prosthetic device or implant or graft NOS (← links)
- Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI) (← links)
- Iatrogenic, infection, urinary catheter (← links)
- Iatrogenic, infection, internal orthopedic prosthetic device or implant or graft or bone device (← links)
- Iatrogenic, infection, internal prosthetic device or implant or graft NOS (← links)
- Resistance to antimicrobials, methicillin (anti-staph penicillins) (← links)
- Colonized with organism (not infected) (← links)
- Surgical follow-up care (← links)
- Renal dialysis care, including dialysis itself (← links)
- Homelessness (← links)
- Organ transplant candidate (waiting for organ) (← links)
- Medical noncompliance (← links)