Episode of care—principal diagnosis, code (ICD-10-AM 5th edn) ANN{.N[N]}

Identifying and definitional attributes
Metadata item type:	Data Element
Short name:	Principal diagnosis
METEOR identifier:	333838
Registration status:	Health, Superseded 05/02/2008
Definition:	The diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care, an episode of residential care or an attendance at the health care establishment, as represented by a code.
Data Element Concept:	Episode of care—principal diagnosis
Value Domain:	Diagnosis code (ICD-10-AM 5th edn) ANN{.N[N]}

Value domain attributes
Representational attributes
Classification scheme:	International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification 5th edition
Representation class:	Code
Data type:	String
Format:	ANN{.N[N]}
Maximum character length:	6

Data element attributes
Collection and usage attributes
Guide for use:	The principal diagnosis must be determined in accordance with the Australian Coding Standards. Each episode of admitted patient care must have a principal diagnosis and may have additional diagnoses. The diagnosis can include a disease, condition, injury, poisoning, sign, symptom, abnormal finding, complaint, or other factor influencing health status. As a minimum requirement the Principal diagnosis code must be a valid code from the current edition of ICD-10-AM. For episodes of admitted patient care, some diagnosis codes are too imprecise or inappropriate to be acceptable as a principal diagnosis and will group to 951Z, 955Z and 956Z in the Australian Refined Diagnosis Related Groups. Diagnosis codes starting with a V, W, X or Y, describing the circumstances that cause an injury, rather than the nature of the injury, cannot be used as principal diagnosis. Diagnosis codes which are morphology codes cannot be used as principal diagnosis.
Collection methods:	A principal diagnosis should be recorded and coded upon separation, for each episode of patient care. The principal diagnosis is derived from and must be substantiated by clinical documentation.
Comments:	The principal diagnosis is one of the most valuable health data elements. It is used for epidemiological research, casemix studies and planning purposes.
Source and reference attributes
Origin:	Health Data Standards Committee National Centre for Classification in Health National Data Standard for Injury Surveillance Advisory Group
Reference documents:	Bramley M, Peasley K, Langtree L and Innes K 2002. The ICD-10-AM Mental Health Manual: an integrated classification and diagnostic tool for community-based mental health services. Sydney: National Centre for Classification in Health, University of Sydney
Relational attributes
Related metadata references:	Supersedes Episode of care—principal diagnosis, code (ICD-10-AM 4th edn) ANN{.N[N]} Health, Superseded 07/12/2005 Has been superseded by Episode of care—principal diagnosis, code (ICD-10-AM 6th edn) ANN{.N[N]} Health, Superseded 22/12/2009 Is used in the formation of Episode of admitted patient care—major diagnostic category, code (AR-DRG v5.1) NN Health, Superseded 22/12/2009
Implementation in Data Set Specifications: All attributes +	Admitted patient care NMDS 2006-07 Health, Superseded 23/10/2006 DSS specific attributes + Implementation start date: 01/07/2006 Implementation end date: 30/06/2007 DSS specific information: The principal diagnosis is a major determinant in the classification of Australian Refined Diagnosis Related Groups and Major Diagnostic Categories. Where the principal diagnosis is recorded prior to discharge (as in the annual census of public psychiatric hospital patients), it is the current provisional principal diagnosis. Only use the admission diagnosis when no other diagnostic information is available. The current provisional diagnosis may be the same as the admission diagnosis. Effective for collection from 01/07/2006 Admitted patient care NMDS 2007-08 Health, Superseded 05/02/2008 DSS specific attributes + Implementation start date: 01/07/2007 Implementation end date: 30/06/2008 DSS specific information: The principal diagnosis is a major determinant in the classification of Australian Refined Diagnosis Related Groups and Major Diagnostic Categories. Where the principal diagnosis is recorded prior to discharge (as in the annual census of public psychiatric hospital patients), it is the current provisional principal diagnosis. Only use the admission diagnosis when no other diagnostic information is available. The current provisional diagnosis may be the same as the admission diagnosis. Effective for collection from 01/07/2006 Admitted patient mental health care NMDS Health, Superseded 23/10/2006 DSS specific attributes + Implementation start date: 01/07/2006 Implementation end date: 30/06/2007 DSS specific information: Effective for collection from 01/07/2006 Admitted patient mental health care NMDS 2007-08 Health, Superseded 05/02/2008 DSS specific attributes + Implementation start date: 01/07/2007 Implementation end date: 30/06/2008 DSS specific information: Effective for collection from 01/07/2006 Admitted patient palliative care NMDS 2006-07 Health, Superseded 23/10/2006 DSS specific attributes + Implementation start date: 01/07/2006 Implementation end date: 30/06/2007 DSS specific information: Effective for collection from 01/07/2006 Admitted patient palliative care NMDS 2007-08 Health, Superseded 05/02/2008 DSS specific attributes + Implementation start date: 01/07/2007 Implementation end date: 30/06/2008 DSS specific information: Effective for collection from 01/07/2006 Community mental health care NMDS 2006-07 Health, Superseded 23/10/2006 DSS specific attributes + Implementation start date: 01/07/2006 Implementation end date: 30/06/2007 DSS specific information: Codes can be used from ICD-10-AM or from The ICD-10-AM Mental Health Manual: An Integrated Classification and Diagnostic Tool for Community-Based Mental Health Services, published by the National Centre for Classification in Health 2002. Effective for collection from 01/07/2006 Community mental health care NMDS 2007-08 Health, Superseded 05/02/2008 DSS specific attributes + Implementation start date: 01/07/2007 Implementation end date: 30/06/2008 DSS specific information: Codes can be used from ICD-10-AM or from The ICD-10-AM Mental Health Manual: An Integrated Classification and Diagnostic Tool for Community-Based Mental Health Services, published by the National Centre for Classification in Health 2002. Effective for collection from 01/07/2006 Residential mental health care NMDS 2006-07 Health, Superseded 23/10/2006 DSS specific attributes + Implementation start date: 01/07/2006 Implementation end date: 30/06/2007 DSS specific information: Codes can be used from ICD-10-AM or from The ICD-10-AM Mental Health Manual: An Integrated Classification and Diagnostic Tool for Community-Based Mental Health Services, published by the National Centre for Classification in Health 2002. The principal diagnosis should be recorded and coded upon the end of an episode of residential care (i.e. annually for continuing residential care). Effective for collection form 01/07/2006 Residential mental health care NMDS 2007-08 Health, Superseded 05/02/2008 DSS specific attributes + Implementation start date: 01/07/2007 Implementation end date: 30/06/2008 DSS specific information: Codes can be used from ICD-10-AM or from The ICD-10-AM Mental Health Manual: An Integrated Classification and Diagnostic Tool for Community-Based Mental Health Services, published by the National Centre for Classification in Health 2002. The principal diagnosis should be recorded and coded upon the end of an episode of residential care (i.e. annually for continuing residential care). Effective for collection form 01/07/2006
Implementation in Indicators:	Used as Numerator National Healthcare Agreement: P22-Selected potentially preventable hospitalisations, 2010 Health, Superseded 08/06/2011 National Healthcare Agreement: P41-Falls resulting in patient harm in hospitals, 2010 Health, Superseded 08/06/2011 National Healthcare Agreement: P42-Intentional self-harm in hospitals, 2010 Health, Superseded 08/06/2011 National Healthcare Agreement: P43-Unplanned/unexpected readmissions within 28 days of selected surgical admissions, 2010 Health, Superseded 08/06/2011 Used as Disaggregation National Indigenous Reform Agreement: P11-Child under 5 hospitalisation rates by principal diagnosis, 2010 Community Services (retired), Superseded 04/04/2011 National Indigenous Reform Agreement: PI 11-Child under 5 hospitalisation rates by principal diagnosis, 2011 Indigenous, Superseded 01/07/2012 National Indigenous Reform Agreement: PI 11-Child under 5 hospitalisation rates by principal diagnosis, 2012 Indigenous, Superseded 13/06/2013