Stream: implementers
Topic: Claim Information for Diagnosis Present on Admission
Lisa Nelson (Jun 08 2018 at 16:04):
Today it is common in the diagnosis information included in a claim to include a boolean saying if the diagnosis was Present on Admission. I was thinking I would capture this information in the diagnosis/type by including vocabulary for the diagnosis/type element that included "PresentOnAdmission" as a possible concept. Someone suggested it may be included in the diagnosis information contained in the Encounter associated with the claim, but I don't see it. Where would you recommend this information to be represented?
Lloyd McKenzie (Jun 08 2018 at 16:11):
@Paul Knapp ?
Paul Knapp (Jun 11 2018 at 14:58):
@Lisa Nelson I haven't seen this supplied in any of the Claim standards, although I haven't checked X12 in detail. Can you show an example claim format where this is supported?
I expect that would be added as a boolean element to the Claim.diagnosis or EOB.diagnosis, and it use in other standards would help drive the determination of whether this was a native element or an extension.
Feroz Mohammed (Jun 11 2018 at 16:58):
would this be a right way to implement it :
{
"resourceType": "Claim",
"id": "960150",
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "654456"
}
]
}
}
"type": {
"coding": [
{
"system": " http://hl7.org/fhir/v2/0895",
"code": "Y"
}
]
}
]
}
Brian Postlethwaite (Jun 25 2018 at 08:00):
The Encounter has the diagnosis backbone element that you can use to specific the admission diagnosis.
This is shown in the example
http://hl7.org/fhir/encounter-example-f202-20130128.xml.html
Paul Knapp (Jul 11 2018 at 11:41):
@Lisa Nelson Is Present On Admission a 'type of diagnosis akin to an admitting diagnosis, discharge diagnosis etc. or is it a different dimension or concept? If it is a different concept then a separate element would be more appropriate otherwise count it simply be added to the existing valueset or in your IG you could specify a choice of valuesets or a valueset which includes multiple codesets?
In @Brian Postlethwaite 's example above he equates the 'admit diagnosis, which I think we already have as a code, with Present on Admission = true. So the question is: is the Present on Admission just a flag to indicate 'this is the admit diagnosis' or is it a flag which could be applied to multiple type of diagnosis to indicate whether it was present at the time of admission?
Michelle (Moseman) Miller (Jul 12 2018 at 13:36):
Present on Admission is a different field than Admitting Diagnosis in the EDI X12 specification.
For example, refer to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding.html
Paul Knapp (Jul 12 2018 at 13:45):
@Michelle (Moseman) Miller @Lisa Nelson Thank you, I'm not familiar with that concept as I have not seen it used anywhere else. (CMS is still using ICD-9??) Clearly it is a separate field so its a matter of whether it is a new element or an extension with the codeset previously indicated.
MaryKay McDaniel (Jul 12 2018 at 17:28):
In the US today, existing claim transactions the Diagnosis Code contains: the DX qualifier (ICD-9, -10, -11), type of DX (principle, admitting, patient's reason for visit, external cause of injury, other), the code itself and then a separate element for the Present On Admission qualifier (as listed on: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding.html)
Last updated: Apr 12 2022 at 19:14 UTC
