Cal. Code Regs. tit. 22 § 97226

Current through Register 2024 Notice Reg. No. 43, October 25, 2024

Section 97226 - Definition of Data Element for Inpatients - Other Diagnoses and Present on Admission Indicator

(a) For discharges occurring on or after January 1, 2023: The patient's other diagnoses are defined as all conditions that coexist at the time of admission, that develop subsequently during the hospital stay, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode that have no bearing on the current hospital stay are to be excluded. Diagnoses shall be coded according to the ICD-10-CM. ICD-10-CM codes from Social Determinants of Health (Z55-Z65) shall be included if they are documented in the medical record. ICD-10-CM codes from External Causes of Morbidity (V00-Y99) shall not be reported as other diagnoses.

(b) Effective with discharges on or after July 1, 2008, whether the patient's other diagnosis was present on admission shall be reported as one of the following:

(1) Y. Yes. Condition was present at the time of inpatient admission.

(2) N. No. Condition was not present at the time of inpatient admission.

(3) U. Unknown. Documentation is insufficient to determine if the condition was present at the time of inpatient admission.

(4) W. Clinically undetermined. Provider is unable to clinically determine whether the condition was present at the time of inpatient admission.

(5) (blank) Exempt from present on admission reporting.

Cal. Code Regs. Tit. 22, § 97226

Note: Authority cited: Section 128810, Health and Safety Code. Reference: Section 128735, Health and Safety Code.

1. New section filed 10-14-93; operative 11-15-93 (Register 93, No. 42).
2. Amendment of section heading and section filed 11-27-95; operative 1-1-96 (Register 95, No. 48).
3. Amendment of subsection (a) and Note filed 7-23-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 30).
4. Amendment of subsections (a) and (b) filed 9-21-98; operative 10-21-98 (Register 98, No. 39).
5. Amendment of section heading and subsection (a) filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 18).
6. Amendment of section heading and subsection (b) and new subsections (c)-(c)(5) filed 11-13-2008; operative 11-13-2008 pursuant to Government Code section 11343.4 (Register 2008, No. 46).
7. Repealer of subsections (b)-(b)(3) and subsection relettering filed 12-31-2009; operative 12-31-2009 pursuant to Government Code section 11343.4 (Register 2010, No. 1).
8. Change without regulatory effect amending subsections (b)(3)-(4) filed 3-25-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 13).
9. Redesignation and amendment of subsection (a) as subsection (a)(1) and new subsection (a)(2) filed 4-3-2014; operative 7-1-2014 (Register 2014, No. 14).
10. Amendment of subsections (a)(1)-(2) filed 9-4-2014; operative 10/1/2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 36).
11. Change without regulatory effect repealing subsection (a)(1) and renumbering subsections filed 7-20-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 30).
12. Change without regulatory effect repealing subsection (a)(1) designator filed 10-31-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 44).
13. Amendment of subsection (a), new subsection (b) and subsection relettering filed 7-18-2022; operative 7/18/2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 29).
14. Change without regulatory effect repealing subsection (a) and relettering subsections filed 12-14-2023 pursuant to section 100, title 1, California Code of Regulations (Register 2023, No. 50).