Episode of care—principal diagnosis, code (ICD-10-AM 7th edn) ANN{.N[N]}

Identifying and definitional attributes
Metadata item type:	Data Element
Short name:	Principal diagnosis—episode of care
METEOR identifier:	391326
Registration status:	Health, Superseded 02/05/2013 National Health Performance Authority (retired), Retired 01/07/2016
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 7th edn) ANN{.N[N]}

Value domain attributes
Representational attributes
Classification scheme:	International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification 7th 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 an error DRG 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 admitted patient care or episode of residential care or attendance at a health care establishment. 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:	National Centre for Classification in Health National Data Standard for Injury Surveillance Advisory Group
Relational attributes
Related metadata references:	Supersedes Episode of care—principal diagnosis, code (ICD-10-AM 6th edn) ANN{.N[N]} Health, Superseded 22/12/2009 Has been superseded by Episode of care—principal diagnosis, code (ICD-10-AM 8th edn) ANN{.N[N]} Health, Superseded 13/11/2014 Tasmanian Health, Standard 02/09/2016 Is used in the formation of Episode of admitted patient care—diagnosis related group, code (AR-DRG v 6) ANNA Health, Standard 30/06/2013 Is used in the formation of Episode of admitted patient care—diagnosis related group, code (AR-DRG v 6.0x) ANNA Tasmanian Health, Superseded 06/09/2016 Is used in the formation of Episode of admitted patient care—diagnosis related group, code (AR-DRG v 7.0) ANNA Tasmanian Health, Standard 06/09/2016 Is used in the formation of Episode of admitted patient care—major diagnostic category, code (AR-DRG v 6) NN Health, Standard 30/06/2013 Tasmanian Health, Superseded 07/09/2016 Is used in the formation of Episode of admitted patient care—major diagnostic category, code (AR-DRG v 8.0) NN Tasmanian Health, Superseded 12/01/2018
Implementation in Data Set Specifications: All attributes +	Acute coronary syndrome (clinical) DSS Health, Superseded 02/05/2013 Admitted patient care NMDS 2010-11 Health, Superseded 18/01/2011 DSS specific attributes + Implementation start date: 01/07/2010 Implementation end date: 30/06/2011 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. Admitted patient care NMDS 2011-12 Health, Superseded 11/04/2012 DSS specific attributes + Implementation start date: 01/07/2011 Implementation end date: 30/06/2012 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. Admitted patient care NMDS 2012-13 Health, Superseded 02/05/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 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. Admitted patient mental health care NMDS 2010-11 Health, Superseded 18/01/2011 DSS specific attributes + Implementation start date: 01/07/2010 Implementation end date: 30/06/2011 DSS specific information: Effective for collection from 01/07/2006 Admitted patient mental health care NMDS 2011-12 Health, Superseded 07/12/2011 DSS specific attributes + Implementation start date: 01/07/2011 Implementation end date: 30/06/2012 DSS specific information: Effective for collection from 01/07/2006 Admitted patient mental health care NMDS 2012-13 Health, Superseded 02/05/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 DSS specific information: Effective for collection from 01/07/2006 Admitted patient palliative care NMDS 2010-11 Health, Superseded 21/12/2010 DSS specific attributes + Implementation start date: 01/07/2010 Implementation end date: 30/06/2011 Admitted patient palliative care NMDS 2011-12 Health, Superseded 07/03/2012 DSS specific attributes + Implementation start date: 01/07/2011 Implementation end date: 30/06/2012 Admitted patient palliative care NMDS 2012-13 Health, Superseded 02/05/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 Community mental health care NMDS 2010-11 Health, Superseded 01/12/2010 DSS specific attributes + Implementation start date: 01/07/2010 Implementation end date: 30/06/2011 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. Community mental health care NMDS 2011-12 Health, Superseded 07/03/2012 DSS specific attributes + Implementation start date: 01/07/2011 Implementation end date: 30/06/2012 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. Community mental health care NMDS 2012-13 Health, Superseded 07/02/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 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. Residential mental health care NMDS 2010-11 Health, Superseded 21/12/2010 DSS specific attributes + Implementation start date: 01/07/2010 Implementation end date: 30/06/2011 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). Residential mental health care NMDS 2011-12 Health, Superseded 07/03/2012 DSS specific attributes + Implementation start date: 01/07/2011 Implementation end date: 30/06/2012 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). Residential mental health care NMDS 2012-13 Health, Superseded 06/09/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 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).
Implementation in Indicators:	Used as Numerator 3.3 Estimated annual number of lumbar spine surgery admissions to hospital per 100,000 people aged 18 years and over, 2010-11 to 2012-13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 3.5 Number of hysterectomy and endometrial ablation admissions to hospital per 100,000 women, 2012-13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 3.8 Number of hip fracture admissions to hospital per 100,000 people aged 65 years and over, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 3.9 Average length of stay for hip fracture patients aged 65 years and over, major and large public hospitals, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.4 Estimated annual number of asthma and related respiratory admissions to hospital per 100,000 people aged 3 to 19 years, 2010-11 to 2012-13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.5 Estimated annual number of asthma admissions to hospital per 100,000 people aged 20 to 44 years, 2010-11 to 2012-13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.6 Number of asthma and COPD admissions to hospital per 100,000 people aged 45 years and over, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.7 Number of heart failure admissions to hospital per 100,000 people aged 40 years and over, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.8 Number of diabetes-related lower limb amputation admissions to hospital per 100,000 people aged 18 years and over, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.9 Average length of stay for stroke patients aged 65 years and over, major and large public hospitals, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 Australian Atlas of Healthcare Variation: Number of cervical loop excision or cervical loop ablation hospitalisations per 100,000 women, aged 15 years and over, 2012-13 to 2014-15 Australian Commission on Safety and Quality in Health Care, Standard 07/06/2017 Australian Atlas of Healthcare Variation: Number of endometrial ablation hospitalisations per 100,000 women, aged 15 years and over, 2012-13 to 2014-15 Australian Commission on Safety and Quality in Health Care, Standard 07/06/2017 Australian Atlas of Healthcare Variation: Number of lumbar spinal decompression (excluding lumbar spinal fusion) hospitalisations per 100,000 people aged 18 years and over, 2012-13 to 2014-15 Australian Commission on Safety and Quality in Health Care, Standard 07/06/2017 Australian Atlas of Healthcare Variation: Number of lumbar spinal fusion (excluding lumbar spinal decompression) hospitalisations per 100,000 people, aged 18 years and over, 2012-13 to 2014-15 Australian Commission on Safety and Quality in Health Care, Standard 07/06/2017 Australian Atlas of Healthcare Variation: Number of lumbar spinal fusion hospitalisations per 100,000 people, aged 18 years and over, 2012-13 to 2014-15 Australian Commission on Safety and Quality in Health Care, Standard 07/06/2017 National Health Performance Authority, Healthy Communities: Number of selected potentially avoidable hospitalisations per 100,000 people, 2011–12 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Median waiting time for surgery for malignant cancer, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Median waiting time for surgery for malignant cancer, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Number of surgeries for malignant cancer, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Number of surgeries for malignant cancer, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who waited longer than the clinical urgency category time for surgery for malignant cancer, 2011-12 National Health Performance Authority (retired), Retired 01/07/2016 National Healthcare Agreement: P04-Incidence of selected cancers, 2010 Health, Superseded 08/06/2011 National Healthcare Agreement: P62-Hospitalisation for injury and poisoning, 2010 Health, Superseded 08/06/2011 National Healthcare Agreement: PB f-By 2014-15, improve the provision of primary care and reduce the proportion of potentially preventable hospital admissions by 7.6 per cent over the 2006-07 baseline to 8.5 per cent of total hospital admissions, 2013 Health, Superseded 30/04/2014 National Healthcare Agreement: PB f-By 2014-15, improve the provision of primary care and reduce the proportion of potentially preventable hospital admissions by 7.6 per cent over the 2006-07 baseline to 8.5 per cent of total hospital admissions, 2014 Health, Superseded 14/01/2015 National Healthcare Agreement: PB f-By 2014-15, improve the provision of primary care and reduce the proportion of potentially preventable hospital admissions by 7.6 per cent over the 2006-07 baseline to 8.5 per cent of total hospital admissions, 2015 Health, Superseded 08/07/2016 National Healthcare Agreement: PI 09-Incidence of heart attacks (acute coronary events), 2015 Health, Superseded 08/07/2016 National Healthcare Agreement: PI 09-Incidence of heart attacks, 2013 Health, Superseded 30/04/2014 National Healthcare Agreement: PI 09-Incidence of heart attacks, 2014 Health, Superseded 14/01/2015 National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2013 Health, Superseded 30/04/2014 National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2014 Health, Superseded 14/01/2015 National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2015 Health, Superseded 08/07/2016 National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2013 Health, Superseded 30/04/2014 National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2014 Health, Superseded 14/01/2015 National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2015 Health, Superseded 08/07/2016 National Healthcare Agreement: PI 27-Number of hospital patient days used by those eligible and waiting for residential aged care, 2013 Health, Superseded 30/04/2014 National Healthcare Agreement: PI 27-Number of hospital patient days used by those eligible and waiting for residential aged care, 2014 Health, Superseded 14/01/2015 National Healthcare Agreement: PI 27-Number of hospital patient days used by those eligible and waiting for residential aged care, 2015 Health, Superseded 08/07/2016 National Indigenous Reform Agreement: P11-Child under 5 hospitalisation rates by principal diagnosis, 2010 Community Services (retired), Superseded 04/04/2011 Number of lumbar spinal decompression (excluding lumbar spinal fusion) hospitalisations per 100,000 people aged 18 years and over, 2012-13 to 2014-15 and 2015-16 to 2017-18 Australian Commission on Safety and Quality in Health Care, Standard 27/04/2021 Number of lumbar spinal fusion (excluding lumbar spinal decompression) hospitalisations per 100,000 people, aged 18 years and over, 2012-13 to 2014-15 and 2015-16 to 2017-18 Australian Commission on Safety and Quality in Health Care, Standard 27/04/2021 Number of lumbar spinal fusion (with or without lumbar spinal decompression) hospitalisations per 100,000 people, aged 18 years and over, 2012-13 to 2014-15 and 2015-16 to 2017-18 Australian Commission on Safety and Quality in Health Care, Standard 27/04/2021 Used as Disaggregation National Health Performance Authority, Hospital Performance: Median waiting time for surgery for malignant cancer, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Median waiting time for surgery for malignant cancer, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Number of surgeries for malignant cancer, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Number of surgeries for malignant cancer, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who waited longer than the clinical urgency category time for surgery for malignant cancer, 2011-12 National Health Performance Authority (retired), Retired 01/07/2016 National Indigenous Reform Agreement: P03-Hospitalisation rates by principal diagnosis, 2010 Community Services (retired), Superseded 04/04/2011 Number of lumbar spinal decompression (excluding lumbar spinal fusion) hospitalisations per 100,000 people aged 18 years and over, 2012-13 to 2014-15 and 2015-16 to 2017-18 Australian Commission on Safety and Quality in Health Care, Standard 27/04/2021 Used as Denominator 3.9 Average length of stay for hip fracture patients aged 65 years and over, major and large public hospitals, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 6.9 Average length of stay for stroke patients aged 65 years and over, major and large public hospitals, 2012–13 Australian Commission on Safety and Quality in Health Care, Standard 23/11/2016 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 30 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2011-12 National Health Performance Authority (retired), Superseded 02/10/2014 National Health Performance Authority, Hospital Performance: Percentage of people who received surgery for malignant cancer within 45 days, 2012-13 National Health Performance Authority (retired), Retired 01/07/2016 National Health Performance Authority, Hospital Performance: Percentage of people who waited longer than the clinical urgency category time for surgery for malignant cancer, 2011-12 National Health Performance Authority (retired), Retired 01/07/2016