Template:ICD10 Guideline Admit vs Acquired: Difference between revisions

From CCMDB Wiki
Jump to navigation Jump to search
(Created page with "<noinclude> This template is used in Comorbid Diagnosis and Admit Diagnosis to give consistent instructions when to use either or neither. To use: <pre>{{ICD10 Guid...")
 
mNo edit summary
Line 12: Line 12:
{{DA | Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review}}
{{DA | Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review}}
{{TT | Placeholder only for now, need to break parts of [[Template:ICD10 Guideline Como vs Admit]] into here instead. }}
{{TT | Placeholder only for now, need to break parts of [[Template:ICD10 Guideline Como vs Admit]] into here instead. }}
==== When to code an [[Admit Diagnosis]] vs [[Acquired Diagnosis]] ====
* Distinction between [[Admit Diagnoses]] and [[Acquired Diagnoses]] relate to the START of a database record.  As of October 2020, a single record may span direct transfers between different locations and even between different services. Accordingly, an [[Admit Diagnosis]] only relates to the very start of a database record. Diagnoses that occur after the start of a database record will be [[Acquired Diagnosis]].
* Dx was present '''prior''' to the start of the record. 
** Example -- 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.
*Examples:
{{Ex |
*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 Diagnosis]] (but this active TB is a [[Comorbid Diagnosis]] )
**Scenario#2:Changes are made to his TB treatment during this admission ---> so IS an [[Admit Diagnosis]] too}}
=== Diagnosis categories in relation to patients moving around the hospital === 
*This section explains rules for how to categorize diagnoses 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)
{{Discuss| Rules 1 and 2 are clear, could rule 3 be further clarified  }}
{{Ex |
*Example1:  Admitted to A=ward for pneumonia --> gets worse sent to B=ICU --> improves sent back to C=ward but still on antibiotics for the pneumonia.  So, 3 distinct database records.  Pneumonia is [[Admit Diagnosis]] for A; [[Admit Diagnosis]] for B; [[Admit Diagnosis]] for C.
**Example2:  Admitted to A=ward for pneumonia --> gets worse sent to B=ICU where the patient improves and is off antibiotics --> improves sent back to C=ward off the antibiotics.  So, 3 distinct database records.  Pneumonia is [[Admit Diagnosis]] for A; [[Admit Diagnosis]] for B; not listed at all for diagnoses for C.
**Example3:  Admitted to A=ward for osteomyelitis --> arrests in A and sent to B=ICU --> while in B the leg gets amputated and the patient finishes up his course of antibiotics so the osteo is now resolved; there have been no further arrythmias and the patient is not on any anti-arrythmics --> improves and goes to C=ward.  So, 3 distinct database records. 
***The osteomyelitis is [[Admit Diagnosis]] for A; [[Admit Diagnosis]] for B; not listed as any diagnosis for C since it's resolved and no longer being treated
***The cardiac arrest is [[Acquired Diagnosis]] for A; [[Admit Diagnosis]] for B; not listed as any diagnosis for C
**Example4:  Admitted to A=ward for osteomyelitis --> arrests in A and sent to B=ICU --> while in B the leg gets amputated and the patient finishes up his course of antibiotics so the osteo is now resolved; there have been no further arrythmias but the patient remains on antiarrythmic therapy --> improves and goes to C=ward still on the antiarrythmics.  So, 3 distinct database records. 
***The osteomyelitis is [[Admit Diagnosis]] for A; [[Admit Diagnosis]] for B; not listed as any diagnosis for C since it's resolved and no longer being treated
***Do not list [[Past history, loss of limb(s)]] for record C since it happened this same hospitalization.
***The cardiac arrest is acquired diagnosis for A; [[Admit Diagnosis]] for B; not listed as any diagnosis for C '''but''' as he is still on antiarrythmics so as an [[Admit Diagnosis]] for C list [[Cardiac arrythmia, NOS]]
*Rule#4: 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. 
}}
=== [[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.

Revision as of 11:47, 2021 April 1

This template is used in Comorbid Diagnosis and Admit Diagnosis to give consistent instructions when to use either or neither.

To use:

{{ICD10 Guideline Como vs Admit}}


Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review

  • SMW


  • Cargo


  • Categories

Placeholder only for now, need to break parts of Template:ICD10 Guideline Como vs Admit into here instead.

  • added: no added date
  • action: no action date
  • Cargo


  • Categories

When to code an Admit Diagnosis vs Acquired Diagnosis

  • Distinction between Admit Diagnoses and Acquired Diagnoses relate to the START of a database record. As of October 2020, a single record may span direct transfers between different locations and even between different services. Accordingly, an Admit Diagnosis only relates to the very start of a database record. Diagnoses that occur after the start of a database record will be Acquired Diagnosis.
  • Dx was present prior to the start of the record.
    • Example -- 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.
  • Examples:
Example:   
  • Patient with TB has been treated for the past 5 (of his 9 expected) months admitted now for acute MI.

Diagnosis categories in relation to patients moving around the hospital

  • This section explains rules for how to categorize diagnoses 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)
Rules 1 and 2 are clear, could rule 3 be further clarified  
  • SMW


  • Cargo


  • Categories
Example:   

testcontent

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.