Ambulatory Care Sensitive Conditions and ICD-9-CM Codes

Ambulatory Care Sensitive conditions such as asthma, diabetes or dehydration are hospitalization conditions where timely and effective ambulatory care can decrease hospitalizations by preventing the onset of an illness or condition, controlling an acute episode of an illness or managing a chronic disease or condition.

High rates of Ambulatory Care Sensitive hospitalizations in a community may be an indicator of a lack of or failure of prevention efforts, a primary care resource shortage, poor performance of primary health care delivery systems, or other factors that create barriers to obtaining timely and effective care.

Ambulatory Care Sensitive Conditions
[and ICD-9-CM Codes]
(By Primary Diagnosis Unless Otherwise Noted)
Avoidable Conditions
Congenital Syphilis [090] Secondary diagnosis for newborns only
Failure to thrive [783.41] Age < 1 Year
Dental Conditions [521-523,525,528]  
Vaccine Preventable Conditions [032,033,037,041.5,045,052.1,
Hemophilus meningitis [320.0] for ages 1-5 only
Iron Deficiency Anemia [280.1,280.8,280.9] Primary & Secondary Diagnoses
Nutritional Deficiencies [260-262,268.0,268.1] Primary & Secondary Diagnoses
Acute Conditions
Bacterial Pneumonia [481,482.2,482.3,482.9,483,485,486] Excludes cases with secondary diagnosis of sickle cell anemia [282.6] and patients less than 2 months
Cancer of the Cervix [180.0-180.1,180.8-180.9]  
Cellulitis [681,682,683,686] Excludes cases with a surgical procedure {01-86.99}, except incision of skin and subcutaneous tissue {86.0} where it is the only listed surgical procedure
Convulsions [780.3]  
Dehydration  - Volume Depletion  [276.5] Principal and secondary diagnoses examined separately
Gastroenteritis [558.9]  
Hypoglycemia [251.2]  
Kidney/Urinary Infection [590.0,599.0,599.9]  
Pelvic Inflammatory Disease [614]
Severe Ear, Nose, & Throat Infections [382,462,463,465,472.1] Excludes otitis media [382] cases with myringotomy with insertion of tube [20.01]
Skin Grafts with Cellulitis {DRGs: 263 & 264} Excludes admissions from SNF/ICF
Chronic Conditions
Angina [411.1,411.8,413] Excludes cases with a surgical procedure {01-86.99}
Asthma [493]  
Chronic Obstructive Pulmonary Disease [466.0,491,492,494,496] Includes acute bronchitis {466.0} only with secondary diagnosis of 491,492,494,496
Congestive Heart Failure [ 402.01,402.11,402.91,428,518.4] Excludes cases with the following surgical procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7
Diabetes [250.0-250.3,250.8-250.9] Excludes diabetes with renal manifestations [250.4], diabetes with ophthalmic manifestations [250.5], diabetes with neurological manifestations [250.6] and diabetes with peripheral circulatory disorders [250.7]
Grand Mal & Other Epileptic Conditions [345]  
Hypertension [401.0,401.9,402.00,402.10,402.90] Excludes cases with the following procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7
Tuberculosis (Non-Pulmonary) [012-018]  
Pulmonary Tuberculosis [011]  

                    Source: Institute of Medicine, "Access to Health Care in America", Michael Millman, Ph.D., Editor,
                                 National Academy Press, Washington, D.C. 1993.