1. ALC, Pneumonia, COPD, Strokes
HS317b – Coding & Classification of Health Data

2. Alternate level of care
Mandatory to record ALC via service transfer area in DAD in all provinces
Designed to separate statistics for true acute care patients from those non-acute patients occupying acute care beds
Has the patient finished the acute care phase of his/her treatment but remains in the acute care bed

3. Standardize data collection Diagnosis type W
Awaiting placement (extended care facility, hospice, residential care home, community services, etc)
No respite care available.
ALC days removed from DAD before national length of stay norms are established.
Standardize data collection
Diagnosis type W

4. Diagnosis Z50.1 Other physical therapy Z51.5 Palliative care
Z54.~ Convalescence
Z59.~ Problems related to housing and economic circumstances
Z60.2 Living alone

5. Diagnosis
Z74.2 Need for assistance at home and no other household member able to render care
Z75.~ Problems related to medical facilities and other health care
Z76.1 Health supervision and care of foundling
Z76.2 Health supervision and care of other healthy infant and child

6. COPD Folio lookup Obstruction, obstructed, obstructive – airway J98.8
– – chronic J44.9
– – with
– – – allergic alveolitis J67.9
– – – asthma NEC J45.9
– – – bronchiectasis J47
– – – bronchitis (chronic) J44.8
– – – emphysema J43.9

7. Chronic Obstructive Pulmonary Diseases (COPD)
A group of common chronic respiratory disorders (progressive, degenerative, obstructive)
Chronic asthmatic bronchitis
Chronic emphysematous bronchitis
Chronic bronchitis with emphysema
Chronic bronchitis with airway obstruction
Chronic obstructive asthma
Chronic obstructive bronchitis
Chronic obstructive tracheobronchitis

8. Coding COPD J44.~
If asthma (J45.~), chronic bronchitis (J42.~) , or emphysema (J43.~) are specified as chronic, obstructive go to J44.~
Note exclusion notes under each condition which direct you to J44.~

9. A patient with COPD presents with a shortness of breath
A patient with COPD presents with a shortness of breath. Chest X-ray revealed evidence of chronic disease of the lungs. He was admitted for treatment of COPD exacerbation.

10. Exacerbation of COPD
Is an acute clinical deterioration in a patient’s respiratory status due to a worsening of underlying COPD
Apply coding rule for acute & chronic in a condition/disease
J44.1 Chronic obstructive pulmonary disease with acute exacerbation, unspecified

11. A patient with COPD presents with a lower respiratory tract infection
A patient with COPD presents with a lower respiratory tract infection. Chest X-ray revealed pneumonia. He was admitted for treatment of COPD exacerbation and pneumonia

12. COPD with acute respiratory infection
Coding rules:
Respiratory tract infections or irritants may trigger an exacerbation
COPD patients high risk for pneumonia.
Use J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
Consider it a ‘combination category’

13. Combination categories
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
J18.9 Pneumonia, unspecified
Create international comparability
ICD-10-CA has combination code for COPD & pneumonia
No implied relationship
It may have an impact on LOS & treatment.

14. Infection & COPD With acute lower respiratory tract infection
Code J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
Additional code is not required to reflect the infective component unless it is specified
i.e. pneumonia or acute bronchitis
A condition in its own right
Assigned a diagnosis type 1

15. Pneumonia Hospital Acquired (nosocomial) Community Acquired infection
Patient with immunosuppressive disease
No further info describing pneumonia
Assign J18.9 Pneumonia, unspecified

16. Infection & Pneumonia Pneumonia…
Escherichia coli (E. coli) J15.5
– – Friedländer's bacillus J15.0
– – Haemophilus influenzae J14
J15.5 Pneumonia due to Escherichia coli

17. Rules for coding pneumonia
If organism is identified by physician follow lookup for appropriate code
Do not use sputum cultures on lab reports
Goes back to rule of ‘Using Diagnostic Test Results in Coding
Microbiology report positive for micro-organism growth but no documentation in physician’s notes identifying diagnosis or treatment…It is inappropriate application of diagnostic tests

18. Pneumonia & HIV HIV disease classified to chapter 1
B24 Human immunodeficiency virus [HIV] disease
Use additional code(s) to identify all manifestations of HIV disease
B24 must be designated as MRDx
Manifestation sequenced immediately following B24

19. Patient with AIDS came in with PCP pneumonia
B24 (M) Human Immunodeficiency virus
B59 (1) Pneumocystosis
J17.3 (3) pneumonia in parasitic disease

20. HIV cases are grouped according to the diagnosis that is placed in the second position on the abstract. If other manifestations are present but not treated during current episode of care, may be assigned diagnosis type 3.

21. Respiratory failure Classified as either acute or chronic
Use J96.~ or J96.1 or J96.9
When the respiratory failure occurs during an episode of care either before any surgical intervention has taken place or after 15 days following any surgical intervention
Use J95.88 (postprocedural) + J96.~ (3)

22. Patient with osteoarthritis of the hip came into hospital for a hip replacement. Surgery was done and two days postoperative patient developed respiratory failure.

23. Postprocedural respiratory failure
J95.88 (2) Other postprocedural respiratory disorder
J96.0 (3) Acute respiratory failure
Y83.~ (9) Surgical procedure…
All postprocedural rules apply

24. Respiratory failure & ARDS
Acute respiratory distress syndrome (J80)
A syndrome of severe respiratory failure associated with pulmonary infiltrates.
A # of clinical conditions associated – Sepsis and systemic inflammatory response syndrome.
Trauma (head injury, pulmonary contusions are strongly associated with development of ARDS
J96.~ is inherent with this syndrome and it is not necessary to code

25. Desaturations Decreased levels of oxygen in the blood.
No specific Folio lookup…
Look for cause.
No lookup use R09.0
Deficiency – oxygen R09.0

26. Mechanical Ventilation
Mechanical Ventilation and continuous positive airway pressure (CPAP)
Methods of supporting intubated patients during illness.
1.GZ.31.~ ~ captures all types of ventilation
Extent attribute is mandatory for code 1.GZ.31.CA-ND using positive pressure mechanical ventilator