Fungemia, NOS: Difference between revisions
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**So, if the patient has a known infection AND/OR '''[[Severe sepsis]]''' OR '''[[Shock, septic]]''' you MUST code those. | **So, if the patient has a known infection AND/OR '''[[Severe sepsis]]''' OR '''[[Shock, septic]]''' you MUST code those. | ||
{{ICD10 Guideline Symptoms not needed when cause known}} | {{ICD10 Guideline Signs Symptoms Test Results not needed when cause known}} | ||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
Latest revision as of 17:56, 2019 January 3
| ICD10 Diagnosis | |
| Dx: | Fungemia, NOS |
| ICD10 code: | B49 |
| Pre-ICD10 counterpart: | OTHER -Fungus |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | none |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- Fungemia is a lab finding, not a disease. Following our general rule, code symptoms, signs and diagnostic abnormalities when the underlying CAUSE is unknown. If that cause is known, then of course you must code it, and coding the abnormal finding is optional.
- So, if the patient has a known infection AND/OR Severe sepsis OR Shock, septic you MUST code those.
Symptom/Sign/Test Result not needed when cause known
- This code identifies a symptom or a sign, or an abnormal test result, not a disorder.
- So, you should code the cause of the symptom/sign/abnormal test, if known -- and if you do so, then also coding and combining the symptom/sign/abnormal test result to that cause is generally optional, but is guided by the following guidelines.
- Here are guidelines for whether or not to ALSO code the symptom/sign/abnormal test when you DO code the underlying cause:
- If it is a subjective symptom (e.g. pain) then coding it is optional
- When it is a physical exam finding (e.g. abdominal tenderness) then coding it is generally optional
- An exception is when the symptom/sign/abnormal testis so severe that all by itself it mandates hospitalization and/or a procedure -- a good example is a patient who has Wegener's granulomatosis is admitted due with Hemoptysis. Since hemoptysis is a physical finding that fits this description of "severe" it should be coded, and combined with Wegener's.
- When it is an abnormal laboratory finding which in and of itself has relevance (e.g. hyperkalemia, hypoalbuminemia) then USUALLY code it
- You don't need to code the abnormal lab finding is when it is actually a major component of the underlying cause --- example is when a person presents with an acute MI, there is no need to code the abnormal troponin as Abnormal blood chemistry NOS
- The trickiest of these guidelines is for abnormal radiologic tests
- When the abnormal test is fully explained by the underlying diagnosis/diagnoses (e.g. pneumonia as cause of abnormal chest imaging, or a skull fracture with an intracranial hemorrhage both identified by an abnormal head CT) then coding the abnormal imaging result is optional
- But remember there are some rare things for which the abnormal imaging result IS part of coding the entity, for example we code retroperitoneal hemorrhage by the combination of Hemorrhage, NOS and Retroperitoneal area, diagnostic imaging, abnormal
- Sometimes there may be multiple symptom/sign/test result that might or might NOT be related to each other by virtue of having the same underlying cause. Since in the absence of KNOWING that cause, such assumptions may well be incorrect, do NOT combine them together if you are not certain they actually have the same underlying cause.
Alternate ICD10s to consider coding instead or in addition
- Shock, septic
- Severe sepsis
- Any infection that is the source of this fungemia.
- Bacteremia
Candidate Combined ICD10 codes
| Fungus codes: |
Infections
Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.
Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site
- This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
- As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
- And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
Attribution of infections
Related CCI Codes
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check ICD10 Inf Potential Infection must have pathogen or alt | CCMDB.accdb | declined |
| Check Inf Antibiotic resistance must have pathogen or Infection with implied pathogen | CCMDB.accdb | implemented |
| Check Inf Infection with implied pathogen must not have a pathogen combined code | CCMDB.accdb | implemented |
| Query check ICD10 Inf Infection req Pathogen must have one | CCMDB.accdb | implemented |
| Query Check Inf Pathogens must have Infection requiring pathogen or Potential Infection | CCMDB.accdb | implemented |
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