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Episode of care—principal diagnosis, code (ICD-10-AM 11th edn) ANN{.N[N]}

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termPrincipal diagnosis
METeOR identifier:Help on this term699609
Registration status:Help on this termHealth, Standard 12/12/2018
Tasmanian Health, Endorsed 08/04/2019
Definition:Help on this term

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 attributes

Representational attributes

Classification scheme:International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification 11th edition
Representation class:Help on this termCode
Data type:Help on this termString
Format:Help on this termANN{.N[N]}
Maximum character length:Help on this term6

Data element attributes

Collection and usage attributes

Guide for use:Help on this term

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 the International statistical classification of diseases and related health problems, 10th revision, Australian modification (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 a principal diagnosis. Diagnosis codes which are morphology codes cannot be used as a principal diagnosis.

Collection methods:Help on this term

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:Help on this term

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:Help on this term

Australian Consortium for Classification Development

National Data Standard for Injury Surveillance Advisory Group

Relational attributes

Related metadata references:Help on this term

See also Episode of care—additional diagnosis, code (ICD-10-AM 11th edn) ANN{.N[N]} Health, Standard 12/12/2018, Tasmanian Health, Endorsed 08/04/2019

Supersedes Episode of care—principal diagnosis, code (ICD-10-AM 10th edn) ANN{.N[N]} Health, Superseded 12/12/2018, Tasmanian Health, Archived 08/04/2019, ACT Health, Final 09/08/2018

Implementation in Data Set Specifications:Help on this term
All attributes +

Activity based funding: Mental health care NBEDS 2019-20 Health, Standard 12/12/2018

DSS specific attributes +

Admitted patient care NMDS 2019-20 Health, Standard 12/12/2018

DSS specific attributes +

Allied health admitted patient care NBPDS Health, Standard 12/12/2018

Community mental health care NMDS 2019–20 Health, Standard 12/12/2018

DSS specific attributes +

Residential mental health care NMDS 2019–20 Health, Standard 12/12/2018

DSS specific attributes +

Tasmanian Admitted Patient Data Set - 2019 Tasmanian Health, Endorsed 12/04/2019

DSS specific attributes +
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