Infections in ICD10: Difference between revisions

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Infections in ICD10 are coded somewhat inconsistently. There are [[#Diagnoses where the pathogen is implied]] and [[#Diagnoses where the pathogen must be coded separately]]. [[#Coding Antibiotic Resistance]] should also be done when there is one.  
Infections in ICD10 are coded somewhat inconsistently. There are [[#Diagnoses where the pathogen is implied]] and [[#Diagnoses where the pathogen must be coded separately]]. [[#Coding Antibiotic Resistance]] should also be done when there is one.  


== Diagnoses where the pathogen is implied ==
=== [[Dx_Date]] infections in [[Acquired Diagnosis / Complication]] ===
[[:category:Infection with implied pathogen|Some infections]] are coded as single codes that imply the pathogen:
*The date we want to use is the date in which the infection first appeared clinically.  This can be a very difficult determination, and may include consideration of:
{{ListICD10Category | categoryName = Infection with implied pathogen}}
**Date on which the clinical signs or symptoms first appeared (e.g. fever, or dysuria, etc)
**Date on which the culture was sent --- but this can be misleading because a culture may not be sent until several days after the symptoms appear.
**Thus, as usual, you must use your clinical judgment to decide when the infection first showed up.


== Diagnoses where the pathogen must be coded separately ==
=== Untreated positive cultures ===
[[:category:Infection requiring pathogen|Some infections]] need to be coded as [[Combined ICD10 codes]] of the condition and the pathogen. For example, [[Pneumonia, bacterial]] and [[Streptococcus pneumoniae]].
*Probably the most common of these is urine and sputum.
*How to code these depends on what the clinical team thinks is true:
**If they're not treating because they think it's NOT an infection and instead is colonization, then code it as one or the other of: [[Colonized with organism (not infected)]] and/or something like [[Urine tests, NOS, abnormal]]
**If on the other hand, they just failed (permanently, or temporarily) to treat what became apparent later to be a real infection, then code it as an infection.


{{Discussion}} For '''acquired''' infections ie. cystitis with a positive culture, now that dates are to accompany acquired diagnoses...which date is to be entered,  
=== Coding when main dx may or may not be an infection ===
*the date culture was sent,
Our program [[Query check ICD10 Inf Infection req Pathogen must have one|requires infections to have a pathogen]], and [[query Check_Inf_Pathogens_must_have_Infection_requiring_pathogen_or_Potential_Infection|does not allow pathogens for non-infections]]. Many of our "wastebasket" [[NOS]] codes could be used for infections and non-infections. In order to be able to code an infection with one of these, you must also code [[Infectious disease NOS]] and the [[Pathogen]] as [[Combined ICD10 codes]].
*the date the positive result was reported,
*or the date abx was ordered?


=== Coding when the pathogen isn't clear (yet) ===
See [[Lab and culture reports]] for where to find pathogen info.


{{Discussion}} In instances of positive urine cultures that are not tx with abx, what is to be coded?
If you don't get a presumptive pathogen and it's not a situation which relates to '''[[Infection with implied pathogen]]''', you should then use '''[[Infectious organism, unknown]]'''.''
*ie. colonization code combined with abnormal test result?


=== Other related information ===
* [[Abscess coding guideline for ICD10]]
* [[Antibiotic Resistant Organism]] (it's is combined-coded)
* [[Lab and culture reports]]
* [[Template:ICD10 Guideline Iatrogenic]]
* [[Attribution of infections]]


{{Discussion}} Are all acquired treated UTI's (post 48 hours from admission) to be coded as iatrogenic infections?
==Cross Checks==
{{ListICD10Category | categoryName = Infection requiring pathogen}}
{{Data Integrity Check List|}}


== Potential Infections ==
== Related articles ==
They can also be coded with diagnoses that can potentially have a pathogen, but don't require one. These are usually disorders that may or may not be infectious in nature.
{{Related Articles}}
{{ListICD10Category | categoryName = Potential infection}}


== Coding Antibiotic Resistance ==
[[Category:Infectious disease| *]]
Antibiotic resistance is combined-coded, see [[Antibiotic Resistant Organism]] for more info.
 
== Lab confirmation of results ==
See [[Pathogens#Culture reports]]
 
=={{CCMDB Data Integrity Checks}}==
{{ICD10|needs review}}
See
* [[Check Infection requiring pathogen must have at least one pathogen]]
* [[Check Infection with implied pathogen must not have a pathogen]]
* [[Check Pathogens must have Infection requiring pathogen or Potential Infection]]
** do we want to go further, e.g. "viral infections must have virus pathogens"?
* [[Check Antibiotic resistance must have pathogen or Infection with implied pathogen]]
** do we want to go further, e.g. "only a fungus can be resistant to antifungal drug"?
{{discussion}}
Are those it? Could we think of more? Would we want to? Ttenbergen 16:59, 2017 December 5 (CST)
 
If we end up with specific pages or sub-headings we should update [[Template:ICD10 Guideline Infection]] to link specifically.
 
[[Category:Infection| *]]

Latest revision as of 10:07, 3 August 2022

Infections in ICD10 are coded somewhat inconsistently. There are #Diagnoses where the pathogen is implied and #Diagnoses where the pathogen must be coded separately. #Coding Antibiotic Resistance should also be done when there is one.

Dx_Date infections in Acquired Diagnosis / Complication

  • The date we want to use is the date in which the infection first appeared clinically. This can be a very difficult determination, and may include consideration of:
    • Date on which the clinical signs or symptoms first appeared (e.g. fever, or dysuria, etc)
    • Date on which the culture was sent --- but this can be misleading because a culture may not be sent until several days after the symptoms appear.
    • Thus, as usual, you must use your clinical judgment to decide when the infection first showed up.

Untreated positive cultures

  • Probably the most common of these is urine and sputum.
  • How to code these depends on what the clinical team thinks is true:
    • If they're not treating because they think it's NOT an infection and instead is colonization, then code it as one or the other of: Colonized with organism (not infected) and/or something like Urine tests, NOS, abnormal
    • If on the other hand, they just failed (permanently, or temporarily) to treat what became apparent later to be a real infection, then code it as an infection.

Coding when main dx may or may not be an infection

Our program requires infections to have a pathogen, and does not allow pathogens for non-infections. Many of our "wastebasket" NOS codes could be used for infections and non-infections. In order to be able to code an infection with one of these, you must also code Infectious disease NOS and the Pathogen as Combined ICD10 codes.

Coding when the pathogen isn't clear (yet)

See Lab and culture reports for where to find pathogen info.

If you don't get a presumptive pathogen and it's not a situation which relates to Infection with implied pathogen, you should then use Infectious organism, unknown.

Other related information

Cross Checks

Data Integrity Checks (automatic list)

 AppStatus
Query check ICD10 Inf Potential Infection must have pathogen or altCCMDB.accdbdeclined
Check Inf Antibiotic resistance must have pathogen or Infection with implied pathogenCCMDB.accdbimplemented
Check Inf Infection with implied pathogen must not have a pathogen combined codeCCMDB.accdbimplemented
Query check ICD10 Inf Infection req Pathogen must have oneCCMDB.accdbimplemented
Query Check Inf Pathogens must have Infection requiring pathogen or Potential InfectionCCMDB.accdbimplemented

Related articles

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