Robert F. Wagner Graduate School of Public Service



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John Billings

Professor

Director, Health Policy and Management Program

Robert F. Wagner School of Public Service

New York University

295 Lafayette Street – 2nd Floor

New York, NY 10012-9604

john.billings@nyu.edu

New York University

A private university in the public service

Attached are the ICD-10-CM diagnostic codes for ACS conditions.

Where only two digits are listed, all diagnoses at the 3rd, 4th, and 5th digit should be included (e.g., asthma is listed as J45, but you should include J45.20, J45.21, J45.22…J45.991, J45.998). Where only three digits are listed, all diagnoses at the 4th, and 5th digit should also be included etc., etc.

All diagnoses refer to principal diagnosis, unless otherwise specified (e.g., dehydration, iron deficiency, nutritional deficiency, etc.). Where exclusions of surgical patients are specified (e.g., hypertension), search all procedure fields for excluded procedures.

Please do not hesitate to contact us if you have any questions.

"Ambulatory Care Sensitive" Conditions

ACS Condition and ICD-10-CM Code(s) Comments

________________________________________________________________________________________

| | |

|Congenital syphilis [A50] |Secondary diagnosis for newborns only |

|Immunization-related and preventable conditions [A33, A34, A35, A37, A80, G000, I01] |Hemophilus meningitis [G002] age 1-5 only |

| | |

|Grand mal status and other epileptic convulsions [G40] | |

|Convulsions "A" [R56] |Age 0-5 |

|Convulsions "B" [R56] |Age >5 |

|Severe ENT infections [H66, J02, J03, J06, J312] |Exclude otitis media cases [H66, H67] with myringotomy with |

| |insertion of tube [Z9622] |

|Pulmonary tuberculosis [A150, A155, A159] | |

|Other tuberculosis [A154, A156, A158, A17, A18, A19] | |

|Chronic obstructive pulmonary disease [J20, J40, J41, J42, J43, J44, J47] |Acute bronchitis [J209] only with secondary diagnosis of J41,|

| |J42, J43, J44, J47 |

|Bacterial pneumonia [J13, J14, J153, J154, J157, J159, J16, J18] |Exclude case with secondary diagnosis of sickle cell [D57] |

| |and patients < 2 months |

|Asthma [J45] | |

|Congestive heart failure [I50, I110, J810] |Exclude cases with a surgical procedure starting with 02 |

|Hypertension [I10, I119, I16] |Exclude cases with a surgical procedure starting with 02 |

|Angina [I20, I240, I248, I249] |Exclude cases with a surgical procedure starting with 0 or 1 |

|Cellulitis [L03, L04, L08, L88, L980] |Exclude cases with a surgical procedure [starting with 0 or |

| |1], except incision of skin and subcutaneous tissue [0H, 0J, |

| |0W, OX] where it is the only listed surgical procedure |

|Skin grafts with cellulitis [AP-DRG 263-264; MS-DRG 573-575] |Exclude admissions from SNF/ICF |

|Diabetes "A" [E101, E131, E110, E130, E10641, E11641] | |

|Diabetes "B" [E106, E116, E108, E118] | |

|Diabetes "C" [E109, E119] | |

|Hypoglycemia [E162] | |

|Gastroenteritis [K529, K5289] | |

|Kidney/urinary infection [N10, N11, N12] | |

|Dehydration - volume depletion [E86] |Examine principal and secondary diagnoses separately |

|Iron deficiency anemia [D501, D508, D509] |Age 0 - 5 only, and examine principal and secondary diagnoses|

| |separately |

|Nutritional deficiencies [E40, E41, E43, E550, E643] |Examine principal and secondary diagnoses separately |

|Failure to thrive [R6251, R6252, R620, R6250] |Age < 1 only |

|Pelvic inflammatory disease [N70, N73] |Women only denominator - exclude cases with a surgical |

| |procedure of hysterectomy [0UT] |

|Dental Conditions [K02, K03, K04, K05, K060, K061, K062, K08, K12, K13, M276, A690, K098] | |

"Marker" Conditions

Condition and ICD-10-CM Code(s) Comments

________________________________________________________________________________________

|Appendicitis with appendectomy [K35, K36, K37] |With principal procedure of 0DTJ |

|Acute myocardial infarction [I21] |Only cases with LOS > 5 days or disposition of death |

|Gastrointestinal Obstruction [K56] | |

|Fracture hip/femur [S720, S721, S722] |Age 45+ only |

"Referral Sensitive" Surgeries

Condition and ICD-10-CM Code(s) Comments

________________________________________________________________________________________

|Hip/joint replacement [0P, 0Q, 0S] | |

|Breast reconstruction after mastectomy [0HH, 0HR] |Women only |

|Pacemaker insertion [02H] | |

|Organ and bone marrow transplant surgeries [02HA, 0FY0, 0TY, 302] | |

|Coronary artery bypass surgery [0210, 0211, 0212, 0213] | |

|Coronary angioplasty [02103, 02104, 02113, 02114, 02123, 02124, 02133, 02134] | |

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