View source for Questions for Kumar Team Meeting June 6, 2012

[[Image: MOTTIFootBall.gif]] '''Questions for Kumar Jun 6 team meet- HSC site submitted'''

#Examples of culture reports to be put up on projector: questions in regards to how to interpret 
*Pat Stein provided four examples


Case examples & questions:

#COPD’s 
*pts thrown onto Antibiotics (IV and/or PO)
*no cultures sent majority of the time
**'''Question: should this be coded as a CAP or bronchitis?'''

*RE: Septicemia - our DX code book says septicemia (bacteremia/fungemia)
#a.) 
*RE: Medicine ward patient 
**Pt admitted with fever NYD
**Blood cultures negative
**Doctor note – not mention of sepsis
***'''Question: How do we code'''? 
#b.) 
*RE: Medicine ward patient
**Pt admitted with DX of being “Septic” as per Doc notes
**Blood cultures negative
**TX with IV then PO antibiotics
***HSC codes as septicemia with subcode negative blood cultures. 
****'''Question: a.) Should this be coded as septicemia?'''  
****'''Question: b.) Is it better to overcode than undercode?'''
          
     
#a.) 
*Patient with pseudomonas in the ETT secretions
**no infiltrate on CXR
**no other signs of symptoms of pneumonia
#b.) 
*Patient has stenotrophomonas maltrophilia in ETT secretions
**no infiltrate on CXR
***'''Question: Which organisms could fall under the category of “resistant organisms WITHOUT infection”?'''
               
#a.) 
*Patient being treated for HAP and has ETT cultures that are +ve for stenotrophomonas maltophilia 
**recovers of first incident of HAP and is off antibiotics
**Gets a “second incident” of HAP.   ETT cultures are now +ve for ecoli and stenotrophomonas.
**for this culture, ecoli is only tested for sensitivity
***'''Question:a.) Is the second incident of HAP due to mixed bacteria or is it ecoli?'''
***'''Question b.) what exactly does it mean when sensitivities on mixed cultures are specific to one organism?'''
***'''Question c.) why are there no sensitivities done on some cultures and no sensitivities are done but antibiotics are given?'''
****Example:  ETT 2+ stenotrohomonas maltophilia & 2+ enterococcus (but no sensitivity done). 


#'''Question: Should cultures +ve with yeast be codes as infection if no treatment?'''


#Shingles – HSC staff use the subcode varicella zoster even if no culture sent.  
*When coding zoster infections of the skin (cellulitis) often the diagnosis is made without a specimen being sent.   It is more important to get the right diagnosis than whether a culture was sent or not, therefore, put in cellulitis and the organism even if a sample was not sent.   If herpetic skin infections are audited the auditor will know that the diagnosis is usually made by clinical observation only. 
***'''Question:  a.) Is the above method correct to capture?''' 
***'''Question:  b.) Are there other infection we should do the same for? Example "thrush"?'''


#'''Question:  Is there a good reference article on types of types of infections in ICU that is current that would be a good resource for collectors?'''


[[Category:Data Collection Team Meetings]]