Web update: Potentially preventable hospitalisations in 2015–16 - Technical Note - Appendix

Web update: Potentially preventable hospitalisations in 2015–16

Appendix

National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2017

This specification can be found online at http://meteor.aihw.gov.au/content/index.phtml/itemId/630028External link, opens in a new window.

Condition ICD- 10-AM codes ICD-10-AM description Additional requirements
Chronic
Asthma J45 Asthma

As principal diagnosis.

Exclude children aged less than 4 years.

J46 Status asthmaticus

As principal diagnosis.

Exclude children aged less than 4 years.

Congestive cardiac failure I50 Heart failure

As principal diagnosis.

Exclude cases with the following cardiac procedure codes:

Blocks 600-606, 608-650, 653-657, 660-664, 666, 669-682, 684-691, 693, 705-707, 717 and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732].

I11.0 Hypertensive heart disease with (congestive) heart failure

As principal diagnosis.

Exclude cases with the following cardiac procedure codes:

Blocks 600-606, 608-650, 653-657, 660-664, 666, 669-682, 684-691, 693, 705-707, 717 and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412- 00[11], 38721-01[733], 90217-02[734], 90215-02[732].

J81 Pulmonary oedema

As principal diagnosis.

Exclude cases with the following cardiac procedure codes:

Blocks 600-606, 608-650, 653-657, 660-664, 666, 669-682, 684-691, 693, 705-707, 717 and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732].

Diabetes complications E10.0– E10.9 Type 1 diabetes mellitus

As principal diagnosis.

E11.0– E11.9 Type 2 diabetes mellitus

As principal diagnosis.

E13.0– E13.9 Other specified diabetes mellitus

As principal diagnosis.

E14.0– E14.9 Unspecified diabetes mellitus

As principal diagnosis.

COPD J20 Acute bronchitis

As principal diagnosis.

Only with additional diagnoses of J41, J42, J43, J44.

J41 Simple and mucopurulent chronic bronchitis

As principal diagnosis.

J42 Unspecified chronic bronchitis

As principal diagnosis.

J43 Emphysema

As principal diagnosis.

J43 Other chronic obstructive pulmonary disease

As principal diagnosis.

Bronchiectasis J47 Bronchiectasis

As principal diagnosis.

J20 Acute bronchitis

As principal diagnosis.

Angina I20 Angina pectoris

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

I24.0 Coronary thrombosis not resulting in myocardial infarction

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

I24.8 Other forms of acute ischaemic heart disease

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

I24.9 Acute ischaemic heart disease, unspecified

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

Iron deficiency anaemia D50.1 Sideropenic dysphagia

As principal diagnosis.

D50.8 Other iron deficiency anaemias

As principal diagnosis.

D50.9 Iron deficiency anaemia, unspecified

As principal diagnosis.

Hypertension I10 Essential (primary) hypertension

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

I11.9 Hypertensive heart disease without (congestive) heart failure

As principal diagnosis.

Exclude cases with the cardiac procedure codes listed for congestive cardiac failure.

Nutritional deficiencies E40 Kwashiorkor

As principal diagnosis.

E41 Nutritional marasmus

As principal diagnosis.

E42 Marasmic kwashiorkor

As principal diagnosis.

E43 Unspecified severe protein-energy malnutrition

As principal diagnosis.

E55.0 Rickets, active

As principal diagnosis.

E64.3 Sequelae of rickets

As principal diagnosis.

Rheumatic heart diseases I00 Rheumatic fever without mention of heart involvement

As principal diagnosis.

I01 Rheumatic fever with heart involvement

As principal diagnosis.

I02 Rheumatic chorea

As principal diagnosis.

I05 Rheumatic mitral valve diseases

As principal diagnosis.

I06 Rheumatic aortic valve diseases

As principal diagnosis.

I07 Rheumatic tricuspid valve diseases

As principal diagnosis.

I08 Multiple valve diseases

As principal diagnosis.

I09 Other rheumatic heart diseases

As principal diagnosis.

Acute
Pneumonia (not vaccine-preventable) J15.3 Pneumonia due to streptococcus, group B

As principal diagnosis.

Exclude people under 2 months.

J15.4 Pneumonia due to other streptococci

As principal diagnosis.

Exclude people under 2 months.

J15.7 Pneumonia due to Mycophasma pneumoniae

As principal diagnosis.

Exclude people under 2 months.

J16.0 Chlamydial pneumonia

As principal diagnosis.

Exclude people under 2 months.

Urinary tract infections, including pyelonephritis N10 Acute tublo-interstitial nephnitis

As principal diagnosis.

N11 Chronic tublo-interstitial nephritis

As principal diagnosis.

N12 Tubolo-interstitial nephritis, not specified as acute or chronic

As principal diagnosis.

N13.1 Pyonephrosis

As principal diagnosis.

N15.1 Renal and perinephric abscess

As principal diagnosis.

N15.9 Renal tubule-interstitial disease, unspecified

As principal diagnosis.

N28.9 Disorders of kidney and ureter, unspecified

As principal diagnosis.

N39.0 Urinary tract infection, site not specified

As principal diagnosis.

N39.9 Disorder or urinary system, unspecified

As principal diagnosis.

Perforated/bleeding ulcer K25.0 Gastric ulcer, acute with haemorrhage

As principal diagnosis.

K25.1 Gastric ulcer, acute with perforation

As principal diagnosis.

K25.2 Gastric ulcer, acute with both haemorrhage and perforation

As principal diagnosis.

K25.4 Gastric ulcer, chronic or unspecified with haemorrhage

As principal diagnosis.

K25.5 Gastric ulcer, chronic or unspecified with perforation

As principal diagnosis.

K25.6 Gastric ulcer, chronic or unspecified with both haemorrhage and perforation

As principal diagnosis.

K26.0 Duodenal ulcer, acute with haemorrhage

As principal diagnosis.

K26.1 Duodenal ulcer, acute with perforation

As principal diagnosis.

K26.2 Duodenal ulcer, acute with both haemorrhage and perforation

As principal diagnosis.

K26.4 Duodenal ulcer, chronic or unspecified with haemorrhage

As principal diagnosis.

K26.5 Duodenal ulcer, chronic or unspecified with perforation

As principal diagnosis.

K26.6 Duodenal ulcer, chronic or unspecified with both haemorrhage and perforation

As principal diagnosis.

K27.0 Peptic ulcer, site unspecified, acute with haemorrhage

As principal diagnosis.

K27.1 Peptic ulcer, site unspecified, acute with perforation

As principal diagnosis.

K27.2 Peptic ulcer, site unspecified, acute with both haemorrhage and perforation

As principal diagnosis.

K27.4 Peptic ulcer, site unspecified, chronic or unspecified with haemorrhage

As principal diagnosis.

K27.5 Peptic ulcer, site unspecified, chronic or unspecified with perforation

As principal diagnosis.

K27.6 Peptic ulcer, site unspecified, chronic or unspecified with both haemorrhage and perforation

As principal diagnosis.

K28.0 Gastrojejunal ulcer, acute with haemorrhage

As principal diagnosis.

K28.1 Gastrojejunal ulcer, acute with perforation

As principal diagnosis.

K28.2 Gastrojejunal ulcer, acute with both haemorrhage and perforation

As principal diagnosis.

K28.4 Gastrojejunal ulcer, chronic or unspecified with haemorrhage

As principal diagnosis.

K28.5 Gastrojejunal ulcer, chronic or unspecified with perforation

As principal diagnosis.

K28.6 Gastrojejunal ulcer, chronic or unspecified with both haemorrhage and perforation

As principal diagnosis.

Cellulitis L02 Cutaneous abscess, furuncle and carbuncle

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L03 Cellulitis

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L04 Acute lymphadenitis

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L08 Other local infections of skin and subcutaneous tissue

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L88 Pyoderma gangrenosum

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L98.0 Pyogenic granuloma

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

L98.3 Eosinphilic cellulitis [Wells]

As principal diagnosis.

Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00 and this is the only listed procedure.

Pelvic inflammatory disease N70 Salpingitis and oophoritis

As principal diagnosis.

N73 Other female pelvic inflammatory diseases

As principal diagnosis.

N74 Other female pelvic inflammatory disorders in diseases classified elsewhere

As principal diagnosis.

Ear, nose and throat infections H66 Suppurative and unspecified otitis media

As principal diagnosis.

J02 Acute pharyngitis

As principal diagnosis.

J03 Acute tonsillitis

As principal diagnosis.

J06 Acute upper respiratory infections of multiple and unspecified sites

As principal diagnosis.

J31.2 Chronic pharyngitis

As principal diagnosis.

Dental conditions K02 Dental caries

As principal diagnosis.

K03 Other diseases of hard tissues of teeth

As principal diagnosis.

K04 Diseases of pulp and periapical tissues

As principal diagnosis.

K05 Gingivitis and periodontal diseases

As principal diagnosis.

K06 Other disorders of gingiva and edentulous alveolar ridge

As principal diagnosis.

K08 Other disorders of teeth and supporting structures

As principal diagnosis.

K09.8 Other cysts of oral region, not elsewhere classified

As principal diagnosis.

K09.9 Cyst of oral region, unspecified

As principal diagnosis.

K12 Stomatitis and related lesions

As principal diagnosis.

K13 Other diseases of lip and oral mucosa

As principal diagnosis.

K14.0 Glossitis

As principal diagnosis.

Convulsions and epilepsy G40 Epilepsy

As principal diagnosis.

G41 Status epilepticus

As principal diagnosis.

R56 Convulsions, not elsewhere classified

As principal diagnosis.

Eclampsia O15 Eclampsia

As principal diagnosis.

Gangrene R02 Gangrene, not elsewhere classified

In any diagnosis.

I70.24 Atherosclerosis of arteries of extremities with gangrene

As principal diagnosis.

E09.52 Impaired glucose regulation with peripheral angiopathy, with gangrene

As principal diagnosis.

Vaccine-preventable
Pneumonia and influenza (vaccine-preventable) J10 Influenza due to other identified influenza virus

In any diagnosis.

Exclude people under 2 months.

J11 Influenza, virus not identified

In any diagnosis.

Exclude people under 2 months.

J13 Pneumonia due to Streptococcus pneumoniae

In any diagnosis.

Exclude people under 2 months.

J14 Pneumonia due to Haemophilus influenza

In any diagnosis.

Exclude people under 2 months.

Other vaccine-preventable conditions A08.0 Rotaviral enteritis

In any diagnosis.

A35 Other tetanus

In any diagnosis.

A36 Diphtheria

In any diagnosis.

A37 Whooping cough

In any diagnosis.

A80 Acute poliomyelitis

In any diagnosis.

B01 Varicella [chicken pox]

In any diagnosis.

B05 Measles

In any diagnosis.

B06 Rubella [German measles]

In any diagnosis.

B16.1 Acute hepatitis B with delta-agent (coinfection) without hepatic coma

In any diagnosis.

B16.9 Acute hepatitis B without delta-agent and without hepatic coma

In any diagnosis.

B18.0 Chronic viral hepatitis B with delta-agent

In any diagnosis.

B18.1 Chronic viral hepatitis B without delta-agent

In any diagnosis.

B26 Mumps

In any diagnosis.

G00.0 Haemophilus meningitis

In any diagnosis.

Notes

The principal diagnosis is the diagnosis established, after study, to be chiefly responsible for occasioning an episode of admitted patient care.

An additional diagnosis is a condition or complaint either coexisting with the principal diagnosis or arising during the episode of admitted patient care.