News/AlertsSites    Medicare E-Library    QUEST
             Useful Web Sites ---------------- 
 HMSA Logo

Complications and Comorbidities


For the purposes of coding diagnoses on claims, a complication is a condition that arises during the hospital stay that prolongs the length of stay. A comorbidity is a pre-existing condition that affects the treatment received and/or prolongs the length of stay.


The chart below shows potential complications and comorbidities associated with a cesarean section and a transurethral prostatectomy.


Examples of potential complications and comorbidities

Procedure Complications Comorbidities
Cesarean section




Ventricular tachycardia

Chronic asthma

Transurethral prostatectomy



Renal complications


Arteriosclerotic heart disease



Implications on DRG

In some cases, DRG payment may change due to patient complications and comorbidities. Complications and comorbidities should be documented in the patient record and listed on the discharge face sheet.


This document incorporates one or more revisions made since it was originally published. See "revision history" for a summary of the revision(s).


First Published:08/22/2007
Latest Revision:01/17/2014

 ---------------- News/AlertsSites    Medicare E-Library    QUEST   ---------------- Useful Web Sites