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Book 1. Data for Metropolitan Areas

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Table A-2: Ambulatory Care Sensitive (ACS) Conditions

ACS Condition and ICD-9-CM Code(s) Comments
Congenital syphilis [090]Secondary diagnosis for newborns only
Immunization-related and preventable conditions [033, 037, 045, 320.0, 390, 391] Hemophilus meningitis [320.2] ages 1-5 only
Grand mal status and other epileptic convulsions [345]  
Convulsions "A" [780.3]Ages 0-5
Convulsions "B" [780.3]Age > 5
Severe ear, nose, and throat infections [382, 462, 463, 465, 472.1] Exclude otitis media cases [382] with myringotomy with insertion of tube [20.01]
Pulmonary tuberculosis [011]  
Other tuberculosis [012-018]  
Chronic obstructive pulmonary disease [491, 492, 494, 496, 466.0] 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] Exclude case with secondary diagnosis of sickle cell [282.6] and patients < 2 months
Asthma [493]  
Congestive heart failure [428, 402.01, 402.11, 402.91, 518.4] Exclude cases with the following surgical procedures: 36.01, 36.02, 36.05, 36.1, 37.5, or 37.7
Hypertension [401.0, 401.9, 402.00, 402.10, 402.90] Exclude cases with the following procedures: 36.01, 36.02, 36.05, 36.1, 37.5, or 37.7
Angina [411.1, 411.8, 413] Exclude cases with a surgical procedure [01-86.99]
Cellulitis [681, 682, 683, 686] Exclude cases with a surgical procedure [01-86.99], except incision of skin and subcutaneous tissue [86.0] where it is the only listed surgical procedure
Skin grafts with cellulitis [primary diagnosis of 681.00, 681.01, 681.02, 681.10, 681.11, 682.0, 682.1, 682.2, 682.3, 682.4, 682.5, 682.6, 682.7, 682.8, 682.9, 707.0, 707.1, 707.8, or 707.9 AND primary or secondary procedure code of 85.82, 85.83, 85.84, 85.85, 86.22, 86.4, 86.60, 86.61, 86.62, 86.63, 86.65, 86.66, 86.69, 86.70, 86.71, 86.72, 86.73, 86.74, 86.75, 86.91, or 86.93]Exclude admissions from skilled nursing facilities or intermediate care facilities
Diabetes "A" [250.1, 250.2, 250.3]  
Diabetes "B" [250.8, 250.9]  
Diabetes "C" [250.0]  
Hypoglycemia [251.2]  
Gastroenteritis [558.9]  

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