Table 1.
ICD-10-AM codes used to identify Ambulatory Care Sensitive Conditions (ACSCs) and exclusions made based on procedure fields
| Category | ICD10 codes | Notes (ICD10) |
|---|---|---|
| Influenza and pneumonia |
J10 J11 J13 J14 J153 J154 J157 J159 J168 J181 J188 |
In any diagnosis field, excludes cases with secondary diagnosis of D57, and people under 2 months |
| Other vaccine preventable |
A35 A36 A37 A80 B05 B06 B161 B169 B180 B181 B26 G000 M014 |
In any diagnosis field |
| Asthma |
J45 J46 |
Principal diagnosis only |
| Congestive heart failure* |
I50 I110 J81 |
Principal diagnosis only, exclude cases with procedure codes according to attached list |
| Diabetes complications |
E101 E102 E103 E104 E105 E106 E107 E108 E110 E111 E112 E113 E114 E115 E116 E117 E118 E130 E131 E132 E133 E134 E135 E136 E137 E138 E140 E141 E142 E143 E144 E145 E146 E147 E148 |
In any diagnosis field |
| Chronic obstructive pulmonary disease |
J20 J41 J42 J43 J44 J47 |
Principal diagnosis only, J20 only with diag2 of J41 J42 J43 J47 J44 |
| Angina |
I20 I240 I248 I249 |
Principal diagnosis only, exclude cases with procedure codes NOT in blocks 1820 to 2140 |
| Iron deficiency anaemia |
D501 D508 D509 |
Principal diagnosis only |
| Hypertension* |
I10 I119 |
Principal diagnosis only, exclude cases with procedure codes according to attached list |
| Nutritional deficiencies |
E40 E41 E42 E43 E550 E643 |
Principal diagnosis only |
| Dehydration and gastroenteritis |
E86 K522 K528 K529 |
Principal diagnosis only |
| Pyelonephritis |
N390 N10 N12 N11 N136 |
Principal diagnosis only |
| Perforated/bleeding ulcer |
K250 K251 K252 K254 K255 K256 K260 K261 K262 K264 K265 K266 K270 K271 K272 K274 K275 K276 K280 K281 K282 K284 K285 K286 |
Principal diagnosis only |
| Cellulitis |
L03 L04 L08 L980 L88 L983 |
Principal diagnosis only, exclude cases with any procedure except those in blocks 1820 to 2016 or if procedure is 30216-02 30676-00 30223-02 30064-00 34527-01 34527-00 90661-00 and this is the only listed procedure |
| Pelvic inflammatory disease |
N70 N73 N74 |
Principal diagnosis only |
| Ear, nose and throat infections |
H66 H67 J02 J03 J06 J312 |
Principal diagnosis only |
| Dental conditions |
K02 K03 K04 K05 K06 K08 K098 K099 K12 K13 |
Principal diagnosis only |
| Convulsions and epilepsy |
O15 G40 G41 R56 |
Principal diagnosis only |
| Gangrene | R02 | In any diagnosis field |
*Procedure codes to use for exclusions for congestive heart failure and hypertension:
33172-00, 35304-00, 35305-00, 35310-02, 35310-00, 38281-11, 38281-07, 38278-01.
38278-00, 38281-02, 38281-01, 38281-00, 38256-00, 38278-03, 38284-00, 38284-02.
38521-09, 38270-01, 38456-19, 38456-15, 38456-12, 38456-11, 38456-10, 38456-07.
38456-01, 38470-00, 38475-00, 38480-02, 38480-01, 38480-00, 38488-06, 38488-04.
38489-04, 38488-02, 38489-03, 38487-00, 38489-02, 38488-00, 38489-00, 38490-00.
38493-00, 38497-04, 38497-03, 38497-02, 38497-01, 38497-00, 38500-00, 38503-00.
38505-00, 38521-04, 38606-00, 38612-00, 38615-00, 38653-00, 38700-02, 38700-00.
38739-00, 38742-02, 38742-00, 38745-00, 38751-02, 38751-00, 38757-02, 38757-01.
38757-00, 90204-00, 90205-00, 90219-00, 90224-00.