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AMBULATORY CARE SENSITIVE CONDITIONS DEFINITIONS AND DATA SOURCES |
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| AMBULATORY
CARE SENSITIVE CONDITIONS
(By Primary Diagnsosis Unless Otherwise Noted) | ICD-9-CM
(For Records Prior 10/01/16) |
ICD-10-CM
(For Records from 10/01/16) |
COMMENTS |
| AVOIDABLE CONDITIONS |
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| Congenital Syphilis |
[090] |
[A50] |
Secondary diagnoses
for newborn only |
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| Failure to Thrive |
[783.41] |
[R6251,R6252,R620,R6250] |
Age < 1 year |
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| Dental Conditions |
[521-523,525,528] |
[K02-K05,K060-K062,K08] |
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[K12-K13,M276,A690,K098] |
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| Vaccine Preventable Conditions |
[033,037,04.5,320.0,390-391] |
[A33-A35,A37,A80,G000,I01] |
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[320.2] age 1-5 only |
[G002] age 1-5 only |
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| Nutritional Deficiencies |
[260-262,268.0,268.1} |
[E40-E41,E43,E550,E643] |
Primary and
secondary diagnoses |
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| ACUTE
CONDITIONS |
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| Bacterial Pneumonia |
[481,482.2-482.3,482.9,483] |
[J13-J14,J153-J154,J157,J159] |
Excludes cases with
second diagnoses of |
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[485-486] |
[J16,J18] |
sickle cell
([282.6] or [D57] for patients |
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less than 2 months. |
| Cancer of the Cervix |
[180.0-180.1,180.8-180.9] |
[C510,C531,C538-C539] |
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| Cellulitis |
[681-683,686] |
[L03-L04,L08,L88,L980] |
Excludes cases w a
surgical procedures (1) |
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except incision of
skin & subcutaneous |
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tissue (2) where it is the only listed |
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surgical procedure. |
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(1) ICD-9-CM =
01-86,99 |
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ICD-10-PS
= starting w 0 or 1 |
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(2) ICD-9-CM =
86.0 |
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ICD-10-PS =
0H,0J,0W,0X] |
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| Convulsion |
[780.3] |
[R56] |
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| Dehydration (Volume Depletion) |
[276.5] |
[E86] |
Principal and
secondary diagnoses |
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examined separately |
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| Gastroenteritis |
[558.9] |
[K529,K5289] |
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| Hypoglycemia |
[251.2] |
[E162] |
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| Kidney/Urinary Infection |
[590.0,599.0,599.9] |
[N10-N12] |
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| Pelvic Inflammatory Disease |
[614] |
[N70,N73] |
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| Severe Ear, Nose & Throat Infections |
[382,462,463,465,472.1] |
[H66,J02,J03,J06,J312] |
Excludes otitis
media cases (1) with |
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myringotomy with
insertion of tube (2) |
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(1) ICD-9CM = 382 |
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ICD-10-PS
= H66-H67 |
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(2) ICD-9-CM =
20.01 |
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ICD-10-PS=C835 |
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| Skin Grafts with Cellutis |
MSDRG = 573-575 |
MSRG = 573-575 |
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| CHRONIC
CONDITIONS |
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| Angina |
[411.1,411.8,413] |
[I20,I240,I248-I249] |
Excludes cases w
surgical procedures : |
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ICD-9-CM =
01-86,99 |
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ICD-10-PS
= starting w 0 or 1 |
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| Asthma |
[493] |
[J45] |
Excludes cases with
the following |
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surgical
procedures: 36.01-36.02,36.05, |
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36.1,37.5 or 37.7
for ICD-9-CM only. |
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| Chronic Obstructive Pulmonary Disease |
[466.0,491,492,494,496] |
[J20,J40-JJ44,J47] |
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[466.0 only w secondary diag. |
J209 only w secondary diag. |
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of 491,492,494,496] |
of J41-J44,J47] |
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| Congestive Heart Failure |
[250.0-250.3,250.8-250.9] |
[I50,I110,J810] |
Excludes cases w a
surgical procedures |
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| Diabetes |
[250.0-250.3,250.8-250.9] |
[E101,E131,E110,E130,E10641] |
[250.0] includes
type 1 or 2 diabetes |
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[250.0] |
[E11641,E106,E116,E118] |
mellitus w ithout
complications |
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[E109,E119] |
[E109,E119]
includes type 1 or 2 |
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diabetes mellitus w
comma, ketoacidosis, |
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Type 1 or 2
diabetes mellitus with or |
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without
complications. |
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| Convultions, Grand Mal Status and Other |
[345] |
[G40] |
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| Epileptic Convulsions |
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| Hypertension |
[401.0,401.9,404.00,402,10 |
[I10,I110] |
Excludes cases with
the following procedures |
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402.90] |
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36.01, 36.02,
36.05, 36.1,37.5,37.7 for ICD-9-CM |
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Excludes cases with
the surgical procedures |
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starting with 1 or
2 for ICD-10-PS. |
| Tuberculosis (Non-Pulmonary) |
[012-018] |
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| Pulmonary Tuberculosis |
[011] |
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| Source: Institute of Medicine, "Access
to Health Care in America", Michael Millman, Ph.D, Editore, National
Academy Press, Washington, D.C., 1993. |
| Ambulatory Sensitive Conditions Listing and
ICD-CM coding Source: John Billings, Professor, Director, Health Policy and
Management Program. |
| Robert F. Wagner School of Public Service,
New York University. |
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| Date: April 4, 2017. |
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