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Access to Health Care in America (1993)
Institute of Medicine (IOM)

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. "Appendix D: Ambulatory-Care Sensitive Conditions and Referral-Sensitive Surgeries." Access to Health Care in America. Washington, DC: The National Academies Press, 1993.

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Access to Health Care in America

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 [DRG 263, DRG 264]

Exclude admissions from SNF/ICF

Diabetes "A" [250.1, 250.2, 250.3]

 

Diabetes "B" [250.8, 250.9]

 

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