In the medical insurance list filling specification, "other diagnosis" is defined as: a situation that coexists at the time of hospitalization, occurs later, or affects the acceptance** and/or length of hospitalization. Complications and comorbidities are included.
Other diagnosesOnly those additional conditions that affect the patient's inpatient course are includedThese additional conditions include: the need for clinical evaluation;or;or diagnostic procedures;or prolonged hospital stay;or increased care and monitoring. An interesting update can be found in the just-released 2024 Official Guide to ICD-10-CM Coding and Reporting. In the definitions of other diagnoses, the above expression has been revised to read "clinically significant additional conditions that affect the patient's current hospitalization". There are four types of conditions regarding whether an additional condition is clinically significant:
1.Pre-existing conditions
Although we know that the list is not the first page, in practice, the list is often the first page. As a result, a large number of previous disease diagnoses that were not clinically significant for this hospitalization were imported into the list. However, according to the above-mentioned reporting principles, these diagnoses should not appear in the health insurance list.
However, a personal or family history of a disease does not have to be inaccessible. If the clinician indicates that these conditions have an impact on the hospitalization, they can be coded as an alternative diagnosis.
2.The test results are abnormal
Abnormal test results (laboratory, x-ray, pathology, etc.) should not be reported unless the clinician indicates that they are clinically significant. If the results are abnormal and the clinician evaluates them further or gives them the appropriate **, the coder can communicate with the clinician whether to add the appropriate diagnosis.
3.The inherent condition of the disease
The intrinsic condition of the disease should not be coded and reported unless otherwise stated in the reference book or coding guide.
For example, if a patient has nausea and vomiting and is diagnosed with gastroenteritis, then only gastroenteritis can be encoded, but not nausea and vomiting, because they are inherent in gastroenteritis.
For example, a patient is admitted to the hospital with fever, cough, and later develops respiratory failure and is diagnosed with pneumonia. Other diagnoses cannot code for fever and cough because they are inherent in pneumonia, and other diagnoses can code for respiratory failure, which is not a routine clinical manifestation of pneumonia. However, in practice, it is not easy to distinguish whether a condition is inherent in a disease or not, especially if these conditions affect the DRG weight.
Original title: Rules for reporting "other diagnoses" in DRG DIP.
* |Lao Xu coded.
Edit |Zhang Chenxuan, Zhang Wenqing.
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