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 tuberculosis | 011 | |
| Other tuberculosis | 012-018 | |
| Vaccine-preventable conditions | 032,033,037,041.5,045,052.1,052.9,055-056,070.0-070.3,072,320.3,390,391, 771.0 | Hemophilus meningitis (320.0) for ages 1-5 only |
| Congenital syphilis | 090 | Secondary diagnosis for newborns only |
| Diabetes with ketoacidosis, hyperosmolarity, or other coma | 250.1-250.3 | |
| Diabetes with hypoglycemia and other specified or unspecified manifestations | 250.8-250.9 | |
| Diabetes without mention of complication | 250.0 | |
| Hypoglycemia | 251.2 | |
| Nutritional deficiencies | 260-262,268.0,268.1 | Primary and secondary diagnoses |
| Dehydration - volume depletion | 276.5 | Principal and secondary diagnoses examined separately |
| Iron deficiency anemia | 280.1,280.8,280.9 | Primary and secondary diagnoses |
| Grand mal status and other epileptic convulsions | 345 | |
| Severe ear, nose, and throat (ENT) infections | 382,462,463,465,472.1 | Excludes otitis media (382) cases with myringotomy with insertion of tube (20.01) |
| Hypertension | 401.0,401.9,402.00,402.10,402.90 | Excludes cases with the following procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7 |
| Congestive heart failure | 402.01,402.11,402.91,428,518.4 | Excludes cases with the following surgical procedures: 36.01,36.02,36.05,36.1,37.5 or 37.7 |
| Angina | 411.1,411.8,413 | Excludes cases with a surgical procedure |
| Chronic obstructive pulmonary disease | 466.0,491,492,494,496 | Includes acute bronchitis (466.0) only with secondary diagnosis of 491,492,494,496 |
| Bacterial pneumonia | 481,482.2,482.3,482.9,483,485,486 | Excludes cases with secondary diagnosis of sickle cell anemia (282.6) and patients less than 2 months |
| Asthma | 493 | |
| Dental conditions | 521-523,525,528 | |
| Gastroenteritis | 558.9 | |
| Kidney/Urinary infection | 590.0,599.0,599.9 | |
| Pelvic inflammatory disease | 614 | |
| Cellulitis | 681,682,683,686 | Excludes 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 cellulitus | DRGs 263 and 264 | Excludes admissions from SNF/ICF |
| Convulsions | 780.3 | |
| Failure to thrive | 783.41 | Age less than 1 year |
