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P-00814 (12/2020) 4 Diagnoses Cues for the Adult Long Term Care Functional Screen (LTCFS) December 2020 This alphabetical listing indicates which box screeners should check on the Diagnoses Table of the Adult LTCFS for diagnoses common to people with long-term care needs. The Diagnoses Table contains categories A through K, with numbered rows within each category. When selecting “Other” in any category, a diagnosis must be entered in the text box provided on the Functional Screen Information Access (FSIA) application. • Screeners must verify a person’s diagnoses. Diagnoses are verified by referring to health records, consulting with a nurse or other health care professional, or if very clearly stated, in exact medical terms, by the person, family, guardian, advocate, etc. Exceptions to these criteria are that a screener must verify a psychiatric, behavioral, dementia or intellectual disability diagnosis directly with a health care provider, medical record, the Children’s Long Term Support Functional Screen or the disability determination diagnosis from the Social Security Administration. See Module 4: Diagnoses, of the Wisconsin LTCFS Instructions for further information on verification of diagnoses. • Do not list any diagnosis that pertains to a condition that has been cured or eliminated by medical treatment, therapy or surgery. Often medical records from health care providers or diagnoses used to find an individual eligible for Social Security benefits are not current. Select diagnoses only for CURRENT conditions. When in doubt, consult with the health care provider treating the person for whom you are completing the LTCFS. • Do not guess which box to check on the Diagnoses Table. For every diagnosis, the screener should: 1. Determine if the diagnosis is listed on the LTCFS Diagnoses Table and select the relevant box on the Diagnoses Table. 2. If a diagnosis is not on the Diagnoses Table, look for it on this cue sheet. Record the corresponding code on the Diagnoses Table. While searching for a diagnosis on this cue sheet, the screener may need to search each of the words in the diagnosis to find the code. An attempt has been made to include newer and older medical terminology, along with non-medical terms for the diagnosis. 3. A key of “Ø” means that the diagnosis is not included on the LTCFS Diagnoses Table and the screener should not code it. The “Ø” symbol has several meanings, including: o The diagnosis is a procedure or surgery; o The diagnosis is not germane to LTCFS eligibility logic; or o The diagnosis is too general and more information is needed to code it. For example, vascular disease is any condition that affects the circulatory system, including aneurysms, arterial insufficiency and bloods clots. Identify and code the more specific diagnosis. P-00814 (12/2020) 4. Any diagnosis with the “Ø” symbol should not be coded as “K5: Other” or “K6: Additional Diagnoses” on the Diagnoses Table. Include diagnoses of this nature in the Notes section of the LTCFS. 5. If the diagnosis is not listed on the LTCFS Diagnoses Table or on this cue sheet and is not needed for a primary or secondary diagnosis, select “K6: Additional Diagnoses” on the LTCFS Diagnoses Table and record the diagnosis in the text box provided. Do not list any diagnosis in “K6: Additional Diagnoses” unless you have verified that the diagnosis is not on this cue sheet or on the Diagnoses Table. 6. If a diagnosis is not listed on the Diagnoses Table or this cue sheet and it is a primary or secondary diagnosis needed to complete the LTCFS, the screen liaison is to contact DHS at [email protected] prior to proceeding with the screen until the DHS screen team has responded with coding information. • This cue sheet is intended to list diagnostic names for discrete conditions, not symptoms that may be present for a number of different conditions or diagnoses. However, common medical practice often uses a symptom as a proxy for a diagnostic name. Therefore, some symptoms have been included on this cue sheet, but this listing is not intended to be complete or all- inclusive. P-00814 (12/2020) Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE 18p Deleti on A7 Acute Bronchitis F2 AAA = Abdominal Aortic Aneurysm C5 Acute Disseminated Encephalomyelitis, E4 AAA Repair Ø if onset at age 22 or after AA A/Triple A Syndrome A9 Acute Disseminated Encephalomyelitis, A3 Aarskog Syndrome A9 if onset before age 22 Abdominal Aneurysm C5 Acute Intermittent Porphyria B6 Abdominal Aortic Aneurysm (AAA) C5 Acute Kidney Injury G3 Abdominal Migraines D12 Acute Toxic Encephalopathy, if onset at E4 Abdominal Pain Ø age 22 or after Acute Toxic Encephalopathy, if onset Abdominal Pannus Ø A3 Abnormal Blood Glucose Ø before age 22 Abnormal Electrocardiogram Ø ADD = Attention Deficit Disorder K2 Abnormal Gait D13 Addiction to Pain Kille rs K1 Abnormal Involuntary Movement D13 Addison's Disease B7 Abnormal Liver Enzyme or Function Adenocarcinoma J2 Ø Tests Adenoid Hypertrophy Ø Abnormal Movement Disorder D13 Adenoidectomy Ø Abnormal Posture Ø Adenoma, Parathyroid B7 Abnormal Weight Gain Ø Adenoma, Pituitary B7 Abnormal Weight Loss Ø Adenomatous Colon Polyps Ø Abov e the Knee Amputation (AKA) D1 Adenopathy/Lymphadenopathy C5 ADHD = Attention Deficit/Hyperactivity Abscess of Liver B4 K2 Abscess of Skin K4 Disorder Absence of Joint (explantation of Adhesions on Colon B5 D4 arthroplasty) Adhesive Capsulitis D4 Absence of Teeth B5 Adjustment Disorder H5 Absence, Agenesis or Dysgenesis of Adrenal Insufficiency B7 A9 Corpus Callosum (ACC or DCC) Adrenal Mass/Tumor, if cancerous and if J2 Acanthosis Nigricans Ø in past 5 years ACC = Absence/A genesis of Corpus Adrenal Mass/Tumor, if noncancerous B7 A9 Callosum Adrenomyeloneuropathy E7 Achalasia B5 Adult Onset Diabetes Mellitus (AODM) B1 Achilles Tendonitis D4 Adult Still's Disease D2 Acid Maltase Deficiency/Pompe Disease B6 Adverse Medication Reactions J1 Acid Peptic Disease B5 Affective Disorder H5 Acid Reflux B5 AFib/AF = Atrial Fibrillation C3 Acidosis (Metabolic) B6 Agenesis of Lung/Pulmonary Agenesis F5 Acidosis (Respiratory) F5 Agenesis/Absence of Corpus Callosum A9 Acne J3 Agent Orange Exposure Ø Acne Rosacea J3 Aggressive Behavior Ø Acquired Immunodeficiency S yndrome Agitation Ø J5 (AIDS) Agoraphobia H1 Acrocallosal Syndrome A7 Agranulocytosis C1 Acrodysostosis A9 AHD = Arteriosclerotic Heart Disease C2 Acromegaly B7 Aicardi Syndrome A7 Actinic Keratosis J3 AIDS = Acquired Immunodeficiency J5 Active Hepatitis B4 Syndrome P-00814 (12/2020) Page 1 of 26 Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Airway Obstruction F5 Angioma, Cerebral, if onset at age 22 or E6 AKA = Above the Knee Amputation D1 after Akathisia D13 Angioma, Cerebral, if onset before age A3 Albinism Ø 22 Albright's Hereditary Os teodystrophy A9 Angioplasty, Coronary or Non -coronary Ø Alcohol and Other Drug Abuse (AODA) K1 Anisometropia I2 Alcohol Dependence In Remission Ø Ankle Edema Ø Alcohol Encephalopathy/Dementia E2 Ankle Equinus D4 Alcohol Related Neurodevelopmental Ankle Fracture D4 A9 Disorder (ARND) Ankle Fusion D4 Alcohol Withdrawal K1 Ankle Ulcer K4 Alcoholic Dementia E2 Ankylosing Spondylitis D2 Alcoholism/Alcohol Abuse/Ad diction/ Anorexia or Anorexia Nervosa B10 K1 Dependence Anoxic Brain Injury, if onset at age 22 or E4 Allergic Conjunctivitis J1 after Allergic Rhinitis J1 Anoxic Brain Injury, if onset before age A3 Allergies J1 22 Alopecia Ø Anoxic Encephalopathy, if onset at age E4 Alport's Syndrome G1 22 or after An oxic Encephalopathy, if onset before ALS = Amyotrophic Lateral Sclerosis D7 A3 Alström Syndrome K5 age 22 Antibiotic Resistant Infections (for Altered Mental Status Ø J6 Alternating Hemiparesis of Childhood example, MRSA) A9 (AHC) Anticoagulation/Anticoagulant Use Ø Alternating Hemiplegia of Childhood A9 Antiphospholipid Antibody Syndrome J7 Alzheimer's Disease E1 Antisynthetase Syndrome J7 Amaurosis Fugax Eye I2 Antral Erosion/Ulcer B5 Amblyopia I2 Anxiety/Anxiety Disorde r H1 Amelia Syndrome (such as tetra) D13 AODA = Alcohol and Other Drug Abuse K1 Amenorrhea G4 AODM = Adult Onset Diabetes Mellitus B1 Amnestic Disorder NOS E7 Aorta Coartation C8 Amnestic Disorder/Syndrome E7 Aortic Aneurysm C5 Amniotic Band Syndrome D13 Aortic Dissection C5 Amputation D1 Aortic Insufficiency C8 Amyloidosis K5 Aortic Regurgitation C8 Amyotrophic Lateral Sclerosis (ALS) D7 Aortic Sclerosis/Aortic Valve Sclerosis C8 Amyotrophy D13 Aortic St enosis/Aortic Valve Stenosis C8 Anal Fissure/Fistula B5 Aortic Valve Disease/Disorder C8 Andersen -Tawil Syndrome K5 Aortoiliac Occlusive Disease C5 Anemia C1 Apert Syndrome A9 Aneurysm, Aortic, Abdominal, or AAA C5 Aphakia I2 Aneurysm, Cerebral, if onset at age 22 Aphasia, Expressive or Receptive E7 E3 or after Apical Calcification (Cardiac) C8 Aneurysm, Cerebral, if onset before age Apical Calcification (Pulmonary) F5 A3 22 Appendectomy Ø Angelman Syndrome A7 Apraxia E7 Angina C2 Arnold -Chiari Malformation Syndrome A7 Arrhythmia C3 P-00814 (12/2020) Page 2 of 26 Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Arsonist K6 Automatic Implantable Cardioverter - C3 Ø Arterial Insufficiency C5 Defibrillator (AICD) Arteriosclerotic Cardiovascular Disease Autonomic Dysfunction/Neuropathy D13 C2 (ASCVD) Autonomic Dysreflexia D13 Arteriosclerotic Heart Disease (AHD) C2 AV (Atriovent ricular) Block C3 Arteriovenous Malformation (AVM) C5 Avascular Necrosis D5 Arteritis C5 Avoidant Restrictive Food Intake B10 Artho gyrposis D6 Azotemia G1 Arthralgia D4 B-12 /B Complex Deficiency
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