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Appendix A - Technical notes for defining Ambulatory care sensitive related hospitalizations (Source: Canadian Institute for Health Information, January 2008)

Numerator:

Inclusion criteria:

Any most responsible diagnosis code of:

Grand mal status and other epileptic convulsions
ICD-9/9CM: 345
ICD-10-CA: G40, G41

Chronic obstructive pulmonary diseases (COPD)

Any most responsible diagnosis (MRDx) code of:

ICD-9/9CM: 491, 492, 494, 496
ICD-10-CA: J41, J42, J43, J44, J47

MRDx of Acute lower respiratory infection, only when a secondary diagnosis of J44 ("Secondary diagnosis" refers to a diagnosis other than most responsible) in ICD-10-CA or 496 in ICD-9/9CM is also present:

ICD-9/9CM: 480 – 486, 466, 487.0
ICD-10-CA: J10.0, J11.0, J12-J16, J18, J20, J21, J22

Asthma

ICD-9/9CM: 493
ICD-10-CA: J45

Diabetes

ICD-9: 250.0, 250.1, 250.2, 250.7
ICD-9-CM: 250.0, 250.1, 250.2, 250.8
ICD-10-CA: E10.0^^, E10.1^^, E10.63, E10.9^^
E11.0^^, E11.1^^, E11.63, E11.9^^
E13.0^^, E13.1^^, E13.63, E13.9^^
E14.0^^, E14.1^^, E14.63, E14.9^^

Heart failure and pulmonary edema (Excluding cases with cardiac procedures)

ICD-9/9CM: 428, 518.4
ICD-10-CA: I50, J81

Hypertension (Excluding cases with cardiac procedures)

ICD-9/9CM: 401.0, 401.9, 402.0, 402.1, 402.9
ICD-10-CA: I10.0, I10.1, I11

Angina (Excluding cases with cardiac procedures)

ICD-9: 411, 413
ICD-9-CM: 411.1, 411.8, 413
ICD-10-CA: I20, I23.82, I24.0, I24.8, I24.9

List of cardiac procedure codes for exclusion (code may be recorded in any position.  Procedures coded as cancelled, previous and "abandoned after onset" are excluded):

CCI: 47^^, 480^-483^, 4891, 4899, 492^-495^, 497^, 498^
ICD-9-CM: 336, 35^^, 36^^, 373^, 375^, 377^, 378^,
3794-3798
CCI: 1HA58, 1HA80, 1HA87, 1HB53, 1HB54, 1HB55,
1HB87, 1HD53, 1HD54, 1HD55, 1HH59, 1HH71, 1HJ76, 1HJ82, 1HM57, 1HM78, 1HM80, 1HN71, 1HN80, 1HN87, 1HP76, 1HP78, 1HP80, 1HP82, 1HP83,  1HP87, 1HR71, 1HR80, 1HR84, 1HR87, 1HS80, 1HS90, 1HT80, 1HT89, 1HT90, 1HU80, 1HU90, 1HV80, 1HV90, 1HW78, 1HW79, 1HX71, 1HX78, 1HX79, 1HX80, 1HX83, 1HX86, 1HX87, 1HY85, 1HZ53 rubric (except 1HZ53LAKP), 1HZ54, 1HZ55 rubric (except 1HZ55LAKP), 1.HZ.56, 1.HZ.57, 1HZ59, 1HZ80, 1HZ85, 1HZ87, 1IF83, 1IJ50, 1IJ54GQAZ, 1IJ55, 1IJ57, 1IJ76, 1IJ80, 1IK57, 1IK80, 1IK87, 1IN84, 1LA84, 1LC84, 1LD84, 1YY54LANJ

Exclusion criteria:

1. Death before discharge
2. Individuals 75 years of age and older

Comments:

A new "combination" code for acute lower respiratory infections in patients with Chronic Obstructive Pulmonary Disease (J44) was introduced with ICD-10-CA and has no equivalents in ICD-9/ICD-9-CM. Cases coded with a primary diagnosis of an acute lower respiratory infection and a secondary diagnosis of J44 in ICD-10-CA or 496 in ICD-9/9CM will be included in the COPD case count. This was undertaken to ensure that COPD cases with acute lower respiratory infections are captured in ICD-9/CM jurisdictions in the same fashion, as they would be in ICD-10-CA jurisdictions, and to compensate for evident erroneous non-application of the combination code in ICD-10-CA jurisdictions.

It was not possible to exclude Dressler's syndrome in jurisdictions coding in ICD-9 as a unique code for this condition does not exist in the ICD-9 classification. As of 2002/03, Quebec is the only jurisdiction in Canada using the ICD-9 classification system, therefore Quebec rates may be slightly higher than elsewhere due to the inclusion of this condition (Dressler's syndrome is coded as 411.0 in ICD-9-CM and I24.1 in ICD-10-CA).

A unique code for Diabetes with hypoglycaemia (ICD-10-CA: E10.63, E11.63, E13.63, E14.63) does not exist in the ICD-9/ ICD-9CM classification systems. This condition was coded using ICD-9 code of 250.7 and ICD-9CM code of 250.8, which also included diabetes with other specific manifestations. However, this has minimal effect on the comparability of rates between ICD-9 and ICD-10 coding jurisdictions.