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Ambulatory Care Sensitive Conditions


Ambulatory Care Sensitive (ACS) conditions are illnesses that can often be managed effectively on an outpatient basis and generally do not result in hospitalization if managed properly.

ACS Condition

ICD-9-CM Diagnosis Codes

Comments

Pulmonary tuberculosis011
Other tuberculosis012-018
Vaccine-preventable conditions032,033,037,041.5,045,052.1,052.9,055-056,070.0-070.3,072,320.3,390,391, 771.0Hemophilus meningitis (320.0) for ages 1-5 only
Congenital syphilis090Secondary diagnosis for newborns only
Diabetes with ketoacidosis, hyperosmolarity, or other coma250.1-250.3
Diabetes with hypoglycemia and other specified or unspecified manifestations250.8-250.9
Diabetes without mention of complication250.0
Hypoglycemia251.2
Nutritional deficiencies260-262,268.0,268.1Primary and secondary diagnoses
Dehydration - volume depletion276.5Principal and secondary diagnoses examined separately
Iron deficiency anemia280.1,280.8,280.9Primary and secondary diagnoses
Grand mal status and other epileptic convulsions345
Severe ear, nose, and throat (ENT) infections382,462,463,465,472.1Excludes otitis media (382) cases with myringotomy with insertion of tube (20.01)
Hypertension401.0,401.9,402.00,402.10,402.90Excludes cases with the following procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7
Congestive heart failure402.01,402.11,402.91,428,518.4Excludes cases with the following surgical procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7
Angina411.1,411.8,413Excludes cases with a surgical procedure
Chronic obstructive pulmonary disease466.0,491,492,494,496Includes acute bronchitis (466.0) only with secondary diagnosis of 491,492,494,496
Bacterial pneumonia481,482.2,482.3,482.9,483,485,486Excludes cases with secondary diagnosis of sickle cell anemia (282.6) and patients less than 2 months
Asthma493
Dental conditions521-523,525,528
Gastroenteritis558.9
Kidney/Urinary infection590.0,599.0,599.9
Pelvic inflammatory disease614
Cellulitis681,682,683,686Excludes cases with a surgical procedure, except incision of skin and subcutaneous tissue (86.0) where it is the only listed surgical procedure
Skin grafts with cellulitusDRGs 263 and 264Excludes admissions from SNF/ICF
Convulsions780.3
Failure to thrive783.41Age less than 1 year


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Content updated: Wed, 15 Nov 2017 07:52:42 EST