Ambulatory Care Sensitive (ACS) Conditions
ICD-9-CM and ICD-10-CM Groupings

Avoidable Conditions
Ambulatory Care
Sensitive Conditions		 ICD-9-CM1 ICD-10-CM2   Comments
Congenital Syphilis 090 A50 Secondary diagnoses for newborn only
Failure to Thrive 783.41 R62.51, R62.52, R62.0, R62.50 Age < 1 only
Dental Conditions 521-523, 525, 528 K02-K05, K060-K062, K08, K12-K13, M27.6, A69.0, K09.8  
Vaccine Preventable Conditions 033, 037, 045, 320.0, 390-391; and
320.2 for ages 1-5 only		 A33-A35, A37, A80, G00.0, I01; and
G00.2 for ages 1-5 only		  
Nutritional Deficiencies 260-262, 268.0, 268.1 E40-E41, E43, E55.0, E64.3 Primary and secondary diagnoses


Acute Conditions
Ambulatory Care
Sensitive Conditions		 ICD-9-CM1 ICD-10-CM2   Comments
Bacterial Pneumonia 481, 482.2-482.3, 482.9, 483,  485-486 J13-J14, J153-J154, J157, J159, J16, J18 Excludes cases with second diagnoses of  sickle cell (ICD-9-CM: 282.6 or ICD-10-CM: D57) and patients less than 2 months old.
Cancer of the Cervix 180.0-180.1, 180.8-180.9 C51.0, C53.1, C53.8-C53.9  
Cellulitis 681-683, 686 L03-L04, L08, L88, L98.0 Excludes cases with a surgical procedures, except:
  1. Procedures of incision of skin & subcutaneous tissue
  2. A sole procedure that is one of the following:
    1. ICD-9-CM = 01-86, 99 ICD-10-PCS = starting with 0 or 1
    2. ICD-9-CM = 86.0 ICD-10-PCS = 0H, 0J, 0W, 0X
Convulsion 780.3 R56  
Dehydration (Volume Depletion) 276.5 E86 Principal and secondary diagnoses
Gastroenteritis 558.9 K52.9, K528.9  
Hypoglycemia 251.2 E16.2  
Kidney/Urinary Infection 590.0, 599.0, 599.9 N10-N12  
Pelvic Inflammatory Disease  614 N70, N73  
Severe Ear, Nose & Throat Infections 382, 462, 463, 465, 472.1 H66, J02, J03, J06, J312 Excludes otitis media cases ( ICD-9-CM = 382) with myringotomy with insertion of tube (ICD-9-CM = 20.01).
Skin Grafts with Cellutis MS-DRG = 573-575 MS-DRG = 573-575 (3)

 

Chronic Conditions
Ambulatory Care
Sensitive Conditions		 ICD-9-CM1 ICD-10-CM2   Comments
Angina  411.1, 411.8, 413  I20, I24.0, I24.8-I24.9 Excludes cases with surgical procedures.
Asthma  493 J45 Excludes cases with the following  surgical procedures: 36.01-36.02, 36.05, 36.1, 37.5 or 37.7 for ICD-9-CM only.
Chronic Obstructive Pulmonary Disease 466.0, 491, 492, 494, 496,  466.0 only with secondary diagnosis of 491, 492, 494, 496 J20, J40-JJ44, J47, J20.9 only with secondary diagnosis of J41-J44, J47  
Congestive Heart Failure 402.01, 402.11, 402.91, 428, 518.4 I50, I11.0, J81.0 Excludes cases with a surgical procedures
Diabetes 250.0-250.3, 250.8-250.9 E10.1, E13.1, E11.0, E13.0, E10.641,  E11.641, E10.6, E11.6, E11.8, E10.9, E11.9  
Grand Mal Status and Other, Epileptic Convulsions 345 G40  
Hypertension 401.0, 401.9, 404.00, 402, 10 I10, I11.0 For ICD-9-CM: excludes cases with the following procedures: 36.01, 36.02, 36.05, 36.1, 37.5, 37.7.
For ICD-10-PCS: excludes cases with the surgical procedures starting with 1 or 2.
Tuberculosis (Non-Pulmonary)  012-018 A15.0, A15.5, A15.9  
Pulmonary Tuberculosis  011 A15.4, A15.6, A15.8, A17, A18, A19  

 

Note:

(1) Diagnosis reported prior to 10/01/16 are coded using ICD-9-CM. The codes are selected by primary diagnosis, unless otherwise noted.
(2) Diagnosis reported after 10/01/16 are coded using ICD-10-CM. The codes are selected by primary diagnosis, unless otherwise noted.
(3) This website uses DRGs defined by an algorithm owned by the 3M Company.

Source:

ACS Listing (ICD-9-CM Groupings): Institute of Medicine, "Access to Health Care in America", Michael Millman, Ph.D, Editore, National Academy Press, Washington, D.C., 1993.
ACS Listing and (ICD-10-CM Groupings): John Billings, Professor, Director, Health Policy and Management Program. Robert F. Wagner School of Public Service, New York University.