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
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 onlyImmunization-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 of0DTJAcute 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]