AMBULATORY CARE SENSITIVE CONDITIONS DEFINITIONS AND DATA SOURCES
AMBULATORY CARE SENSITIVE CONDITIONS            (By Primary Diagnsosis Unless Otherwise Noted) ICD-9-CM                                             (For Records Prior 10/01/16) ICD-10-CM                                             (For Records from 10/01/16) COMMENTS
AVOIDABLE CONDITIONS
       
 Congenital Syphilis  [090]  [A50]  Secondary diagnoses for newborn only
       
 Failure to Thrive  [783.41]  [R6251,R6252,R620,R6250]  Age < 1 year
       
 Dental Conditions  [521-523,525,528]  [K02-K05,K060-K062,K08]  
     [K12-K13,M276,A690,K098]  
       
 Vaccine Preventable Conditions  [033,037,04.5,320.0,390-391]  [A33-A35,A37,A80,G000,I01]  
   [320.2] age 1-5 only  [G002] age 1-5 only  
       
 Nutritional Deficiencies  [260-262,268.0,268.1}  [E40-E41,E43,E550,E643]  Primary and secondary diagnoses
       
ACUTE CONDITIONS      
       
 Bacterial Pneumonia  [481,482.2-482.3,482.9,483]  [J13-J14,J153-J154,J157,J159]  Excludes cases with second diagnoses of
   [485-486]  [J16,J18]  sickle cell ([282.6] or [D57] for patients
       less than 2 months.
 Cancer of the Cervix  [180.0-180.1,180.8-180.9]  [C510,C531,C538-C539]  
       
 Cellulitis  [681-683,686]  [L03-L04,L08,L88,L980]  Excludes cases w a surgical procedures (1)
       except incision of skin & subcutaneous
       tissue  (2) where it is the only listed 
       surgical procedure.
         (1) ICD-9-CM = 01-86,99
                ICD-10-PS = starting w 0 or 1
        (2) ICD-9-CM = 86.0
               ICD-10-PS = 0H,0J,0W,0X]
       
 Convulsion  [780.3]  [R56]  
       
 Dehydration (Volume Depletion)  [276.5]  [E86]  Principal and secondary diagnoses
       examined separately
       
 Gastroenteritis  [558.9]  [K529,K5289]  
       
 Hypoglycemia  [251.2]  [E162]  
       
 Kidney/Urinary Infection  [590.0,599.0,599.9]  [N10-N12]  
       
 Pelvic Inflammatory Disease  [614]  [N70,N73]  
       
 Severe Ear, Nose & Throat Infections  [382,462,463,465,472.1]  [H66,J02,J03,J06,J312]   Excludes otitis media cases (1) with
        myringotomy with insertion of tube (2)
         (1) ICD-9CM = 382
                ICD-10-PS = H66-H67
         (2) ICD-9-CM = 20.01
                ICD-10-PS=C835
       
  Skin Grafts with Cellutis  MSDRG = 573-575   MSRG = 573-575  
       
CHRONIC CONDITIONS      
       
  Angina  [411.1,411.8,413]  [I20,I240,I248-I249]  Excludes cases w surgical procedures :
                ICD-9-CM = 01-86,99
                ICD-10-PS = starting w 0 or 1
       
 Asthma  [493]  [J45]  Excludes cases with the following
       surgical procedures: 36.01-36.02,36.05,
       36.1,37.5 or 37.7 for ICD-9-CM only.
       
 Chronic Obstructive Pulmonary Disease  [466.0,491,492,494,496]  [J20,J40-JJ44,J47]  
   [466.0 only w secondary diag.  J209 only w secondary diag.  
    of 491,492,494,496]  of J41-J44,J47]  
       
 Congestive Heart Failure  [250.0-250.3,250.8-250.9]  [I50,I110,J810]  Excludes cases w a surgical procedures
       
  Diabetes   [250.0-250.3,250.8-250.9]  [E101,E131,E110,E130,E10641]  [250.0] includes type 1 or 2 diabetes
   [250.0]  [E11641,E106,E116,E118]  mellitus w ithout complications
     [E109,E119]  [E109,E119] includes type 1 or 2
       diabetes mellitus w comma, ketoacidosis,
       Type 1 or 2 diabetes mellitus with or
       without complications.
       
 Convultions, Grand Mal Status and Other  [345]  [G40]  
 Epileptic Convulsions      
       
 Hypertension  [401.0,401.9,404.00,402,10  [I10,I110]  Excludes cases with the following procedures
   402.90]    36.01, 36.02, 36.05, 36.1,37.5,37.7 for ICD-9-CM
       Excludes cases with the surgical procedures
       starting with 1 or 2 for ICD-10-PS.
 Tuberculosis (Non-Pulmonary)  [012-018]    
       
 Pulmonary Tuberculosis  [011]    
       
 Source: Institute of Medicine, "Access to Health Care in America", Michael Millman, Ph.D, Editore, National Academy Press, Washington, D.C., 1993.
 Ambulatory Sensitive Conditions Listing and ICD-CM coding Source: John Billings, Professor, Director, Health Policy and Management Program. 
 Robert F. Wagner School of Public Service, New York University.
 Date: April 4, 2017.