Diagnosis typing, prefixes and clusters
A code on its own is not an abstract entry. It has to be typed, may need a prefix, and may have to be clustered with the code that explains it. These are the systems that govern that, with the standard to read for each.
Diagnosis types (DAD)
| النوع | الاسم | Meaning | Standard |
|---|---|---|---|
| M | Most responsible diagnosis | The single condition most responsible for the patient's stay. Where more than one qualifies, choose the one accounting for the greatest portion of the length of stay or the greatest use of resources. If no intervention was performed, the first-listed diagnosis is selected; if no definite diagnosis was reached, the main symptom, abnormal finding or problem is. | Diagnosis Typing Definitions for DAD |
| 1 | Pre-admit comorbidity | A condition that existed before admission and meets at least one of the three criteria for significance. | Diagnosis Typing Definitions for DAD |
| 2 | Post-admit comorbidity | A condition that arose after admission and meets at least one criterion for significance. Takes prefix 5 or 6 to place it relative to the first qualifying intervention. If it also qualifies as the most responsible diagnosis it is recorded both as type (M) and as type (2). | Diagnosis Typing Definitions for DAD |
| 3 | Secondary diagnosis | Documented but not meeting a criterion for significance. Optional unless another standard requires it. Diagnoses appearing only on the front sheet, discharge summary, history and physical, or pre-operative anaesthetic consult fall here unless supported elsewhere in the record. | Diagnosis Typing Definitions for DAD |
| 5 | Admitting diagnosis | The diagnosis recorded at the point of admission. | Diagnosis Typing Definitions for DAD |
| 6 | Proxy most responsible diagnosis | Stands in for the most responsible diagnosis where the classification requires a proxy. | Diagnosis Typing Definitions for DAD |
| 9 | External cause of injury code | The circumstance that produced an injury, poisoning or adverse effect (V01-Y98). Mandatory alongside the injury itself. | External Cause Codes |
| 0 | Newborn | A condition of the newborn, recorded on a newborn abstract. | Diagnosis Typing Definitions for DAD |
Diagnosis prefixes
| Prefix | Marks | Restriction | Standard |
|---|---|---|---|
| 5 |
Arose before the first qualifying intervention
Applied to a post-admit comorbidity (type 2) that arose before the first qualifying intervention episode.
|
Acute inpatients only. Obstetrical conditions (O00-O99) are excluded. Takes precedence over prefixes Q and C and over facility-defined prefixes. | Diagnosis Typing Definitions for DAD |
| 6 |
Arose during or after the first qualifying intervention
Applied to a post-admit comorbidity (type 2) that arose during or after the first qualifying intervention episode.
|
Acute inpatients only. Obstetrical conditions (O00-O99) are excluded. Takes precedence over prefixes Q and C and over facility-defined prefixes. | Diagnosis Typing Definitions for DAD |
| 8 |
Palliative care
Marks an episode of palliative care.
|
Restricted to Z51.5. | Palliative Care |
| J |
Underlying condition leading to a MAID request
Marks the condition that led the patient to request medical assistance in dying.
|
— | Medical Assistance in Dying |
| N |
Pressure ulcer documented by allied health only
Marks a pressure ulcer diagnosis documented solely by a regulated allied health professional rather than by the physician or primary care provider.
|
Restricted to category L89. | Pressure Ulcers |
| Q |
Query / suspected diagnosis
Marks a diagnosis documented as probable, suspected, questionable or rule-out, where the jurisdiction uses the query prefix.
|
— | Unconfirmed Diagnosis |
| C |
Cause of death
Marks a condition that contributed to the patient's death.
|
— | Diagnosis Typing Definitions for DAD |
NACRS problem types
The problem deemed the clinically significant reason for the visit, requiring evaluation, treatment or management, and assigned by the health care provider at the end of the visit. Where several problems compete, the one responsible for the greatest use of resources. For a patient who left without being seen, the presenting complaint.
Main and Other Problem Definitions for NACRS
Mandatory where the condition or circumstance exists at the time of the visit and is significant to treatment or care - that is, it requires monitoring and/or treatment - or where another standard or the classification itself directs it. Optional otherwise.
Optional capture is only reliable when mandated jurisdiction-wide or facility-wide; ad hoc assignment by individual coders is not valid for use.
Coding of Main and Other Problems for NACRS
Diagnosis clusters
Clustering links codes that must be read together, so downstream analysis does not treat a manifestation or a complication as an independent condition.
Dagger and asterisk
An aetiology code (dagger) sequenced before the manifestation code (asterisk) it gives rise to. The asterisk code can never stand alone as a primary diagnosis.
Dagger/Asterisk Convention
Injury with external cause
An injury, poisoning or adverse effect clustered with the external cause code that produced it, and with a place-of-occurrence code where the jurisdiction requires one.
External Cause Codes
Device or procedural complication
A complication of an internal device, implant or graft clustered with the external cause code identifying the procedure that placed it. A post-implant problem is not coded to a primary disease of the joint or organ.
Diagnosis Cluster
Underlying condition with manifestation
A systemic condition clustered with the organ-specific manifestation it produced, so downstream analysis does not read them as unrelated.
Diagnosis Cluster
Clinical specialties
How each specialty is defined for filtering: most by anatomy, some by pathology. Oncology reads neoplasms of every organ and emergency medicine reads trauma of every organ, so defining those by body system would match everything and narrow nothing. Our own editorial mapping, not part of the coding standards.
| Specialty | Body systems | Diagnostic categories | |
|---|---|---|---|
| Cardiology | cardiovascular | — | Browse codes |
| Respirology | respiratory | — | Browse codes |
| Gastroenterology | digestive | — | Browse codes |
| Nephrology | urinary | — | Browse codes |
| Urology | urinary, reproductive | — | Browse codes |
| Neurology | nervous | — | Browse codes |
| Neurosurgery | nervous | — | Browse codes |
| Endocrinology | endocrine | — | Browse codes |
| Haematology | lymphatic | — | Browse codes |
| Orthopaedics | musculoskeletal | — | Browse codes |
| Dermatology | integumentary | — | Browse codes |
| Ophthalmology | special_sense | — | Browse codes |
| Otolaryngology | special_sense | — | Browse codes |
| General surgery | digestive, lymphatic | — | Browse codes |
| Psychiatry | — | — | Browse codes |
| Obstetrics & gynaecology | reproductive | — | Browse codes |
| Neonatology | — | — | Browse codes |
| Medical genetics | — | congenital | Browse codes |
| Oncology | — | neoplasm | Browse codes |
| Infectious disease | — | inflammatory | Browse codes |
| Emergency medicine | — | trauma | Browse codes |
| Patient safety | — | iatrogenic | Browse codes |
| Rheumatology | musculoskeletal | degenerative | Browse codes |
| Health information management | — | — | Browse codes |
Canadian Institute for Health Information. Canadian Coding Standards for Version 2022 ICD-10-CA and CCI. Ottawa, ON: CIHI; 2022.
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