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Z53.21
ICD-10-CM
Left Against Medical Advice

Understanding Left Against Medical Advice (AMA)? This guide covers AMA documentation, discharge procedures, medical coding for AMA events, and the implications for healthcare providers and patients. Learn about AMA forms, the AMA process, and best practices for documenting AMA discharges. Explore related terms such as hospital AMA, patient AMA, AMA discharge instructions, and AMA documentation guidelines. Find information on ICD-10 codes for AMA and the impact of AMA on healthcare reimbursement.

Also known as

Left AMA
Discharged Against Medical Advice

Diagnosis Snapshot

Key Facts
  • Definition : Patient chooses to leave before recommended treatment is complete.
  • Clinical Signs : None specific to LAMA, relates to underlying condition. May include refusal of medication or procedures.
  • Common Settings : Emergency departments, inpatient wards, outpatient clinics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC Z53.21 Coding
Z99

Factors influencing health status

Codes for reasons for encounters besides illness or injury.

Z53

Persons encountering health services

Describes patients' reasons for encountering healthcare.

Z73

Stressors related to lifestyle

Covers lifestyle factors impacting health, though not typically used for AMA.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Left Against Medical Advice
Discharge AMA
Non-Compliance with Treatment

Documentation Best Practices

Documentation Checklist
  • Document patient's capacity to make decisions.
  • Clearly document risks/benefits discussion.
  • Document patient's understanding of risks.
  • Document alternatives offered to the patient.
  • Signed AMA form or documented refusal.

Mitigation Tips

Best Practices
  • Document patient's AMA understanding using ICD-10 Z99.1
  • CDI: Thoroughly chart patient capacity, risks, alternatives
  • Offer alternative treatments, document refusal for compliance
  • Ensure AMA form includes patient signature, witness, date
  • Patient education crucial, document provided resources, referrals

Clinical Decision Support

Checklist
  • Confirm patient capacity to make decisions
  • Document patient understanding of risks
  • Offered alternative treatments/options
  • AMA form signed and witnessed
  • Discharge instructions provided/documented

Reimbursement and Quality Metrics

Impact Summary
  • Left Against Medical Advice (LAMA), coding accuracy impacts reimbursement through proper ICD-10 Z codes (Z99.1, etc.), impacting case mix index (CMI).
  • LAMA increases hospital readmission risk, impacting quality metrics like 30-day readmission rates and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
  • Accurate LAMA documentation improves risk adjustment and reduces claim denials, crucial for appropriate reimbursement and revenue cycle management.
  • LAMA rates contribute to publicly reported hospital quality data, impacting hospital reputation and potential penalties tied to value-based purchasing programs.

Streamline Your Medical Coding

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Quick Tips

Practical Coding Tips
  • Document AMA discussion thoroughly
  • Code Z99.1 for LAMA accurately
  • Query physician for AMA clarification
  • Ensure informed refusal documentation
  • Check payer guidelines for AMA

Documentation Templates

Patient presented today with [chief complaint].  History of present illness elicited [relevant details of symptoms, duration, and related factors].  Physical examination revealed [objective findings].  Differential diagnosis included [list of possible diagnoses].  A treatment plan was recommended consisting of [specific interventions, medications, andor procedures].  The risks and benefits of the proposed treatment plan were thoroughly explained to the patient, including potential complications and alternative treatment options.  Despite medical advice and recommendations, the patient elected to leave against medical advice (AMA).  The patient was informed of the potential risks associated with leaving AMA, including but not limited to worsening of the current condition, development of complications, and potential for adverse outcomes.  Documentation provided to the patient regarding leaving AMA included information on follow-up care, urgent care options, and emergency contact information.  The patient verbally acknowledged understanding of the risks and confirmed their decision to leave AMA.  All questions were answered, and the patient departed the facility.  Discharge disposition: Left Against Medical Advice.  Relevant ICD-10 code: V64.1 (Left against medical advice).  Future medical care and treatment options were discussed with the patient prior to departure.