Isolation, infectious: Difference between revisions

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==Additional Info==

*This is a procedure code for a patient who is on ~~any sort of~~ infection isolation precautions.

=== Code as Acquired Procedure ===

*While this can be an [[Admit Procedure]] or an [[Acquired Procedure]], it usually will be coded as an [[Acquired Procedure]]. It's counter-intuitive, but review the documentation at [[Acquired Procedure]]/[[Admit Procedure]] and it should be clear why.

*It can, on occasion be coded as both an [[Admit Procedure]] and (later in the admission) as a separate [[Acquired Procedure]].

=== Definition ===

*This is a procedure code for a patient who is on infection isolation precautions.

*The person does NOT have to turn out to have the condition for which isolation is indicated.

**Thus use it if a patient is put on isolation for TB, or COVID-19 even if they turn out NOT to have those infections.

**Can also use it for somebody put on isolation prophylactically, as is the case with reverse isolation.

*It '''includes''' any/all of the following kinds of isolation protocols:

**gloves only

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**mask

**negative pressure room use

**reverse isolation

**reverse isolation -- i.e. a person at risk for getting infection (e.g. neutropenic after chemotherapy for cancer) is isolated to try and avoid them being exposed

**cohorting the patient with other patients with the same [[Pathogens|pathogen]]

**use for those AGMP's that are continuous e.g. BIPAP, CPAP, Optiflow . As of May10,2023 only those patients designated as "orange", or "red" require isolation/PPE precautions. "green" patients have no special precautions. Do not use for one time AGMP's where there is no other indication for isolation. e.g intubation, bronchoscopy, CPR, nebulizer medications

=== In the context of [[Colonized with organism (not infected)]] ===

*If ~~a patient is placed on [[Isolation, infectious]] on arrival '''''only'''''~~ for the ~~reason~~ of ~~pre existing MRSA (or other colonization), then code~~ [[Admit ~~Diagnosis~~]] ~~[[Colonized with organism (~~not ~~infected)]] and code the isolation as an~~ [[~~Admit~~ Procedure]].

*This code could be either an Admit or Acquired procedure.

**If it qualifies for the rules of [[Admit Procedure]] then use that. If not, use [[Acquired Procedure]].

*For patients who have MRSA in comorbs, and are admitted for ~~other reasons, put [[Isolation, infectious]] in '''acquired''' CCI codes.~~

=== Do not use this code for isolation for Use of Cytotoxic Agents ===

*This is NOT included because such isolation (e.g. keeping pregnant nurses from caring for patients getting certain teratogenic medications) is not isolating the patient.

~~{{DiscussTask | For patients who are admitted and have pre existing MRSA to code infectious~~ isolation as an '''acquired''' CCI code is counterintuitive if it is present and treated with isolation on admission. Pre existing colonization would be included as an ADMIT DX if treated with isolation, and the isolation would be included as an admit CCI procedure.

*I agree, it does feel counterintuitive, but if we are following the WIKI guidelines, it seems like this is how we are supposed to code it. I think their is currently a lot of ~~discrepancy in how this is being coded.~~

**there seems to be confusion all around when to code something as an admit vs acquired vs comorbid. One example we have seen, someone comes in to ICU with stab would injury to heart, has had cardiac arrests, and is ~~in shock~~. ~~We see the trauma injury to heart coded as comordid~~. ~~Need to discuss collection instruction tweek that would help~~

*** Allan recently updated [[Admit Procedure]] with info that is ~~relevant to this. I wonder if the instructions on this page are just a remnant from an earlier iteration of~~ the ~~Admit instructions. As I read the current ones, you would not code this. But yes, good we are taking it to Task..~~. }}

==~~= Isolation for Use of Cytotoxic Agents =~~==

== Related Code ==

*This is ~~NOT included because such~~ isolation (~~e.g. keeping pregnant nurses from caring for patients getting certain teratogenic medications~~) ~~is not isolating the patient~~.

This code is similar to [[Patient is on isolation (TISS Item)]] but collected as a different [[CCI Collection Mode]], so we decided to keep both.

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==Related ICD10 Codes==

== Data use ==

* [[Directors Quarterly and Annual Report (Medicine)|Directors Quarterly and Annual Report]]

== Related Articles ==

@@ Line 7: / Line 7: @@
 ==Additional Info==
-*This is a procedure code for a patient who is on any sort of infection isolation precautions.
+=== Code as Acquired Procedure ===
+*While this can be an [[Admit Procedure]] or an [[Acquired Procedure]], it usually will be coded as an [[Acquired Procedure]]. It's counter-intuitive, but review the documentation at [[Acquired Procedure]]/[[Admit Procedure]] and it should be clear why.
+*It can, on occasion be coded as both an [[Admit Procedure]] and (later in the admission) as a separate [[Acquired Procedure]].
+=== Definition ===
+*This is a procedure code for a patient who is on infection isolation precautions.
+*The person does NOT have to turn out to have the condition for which isolation is indicated.
+**Thus use it if a patient is put on isolation for TB, or COVID-19 even if they turn out NOT to have those infections.
+**Can also use it for somebody put on isolation prophylactically, as is the case with reverse isolation.
 *It '''includes''' any/all of the following kinds of isolation protocols:
 **gloves only
@@ Line 13: / Line 21: @@
 **mask
 **negative pressure room use
-**reverse isolation
+**reverse isolation -- i.e. a person at risk for getting infection (e.g. neutropenic after chemotherapy for cancer) is isolated to try and avoid them being exposed
 **cohorting the patient with other patients with the same [[Pathogens|pathogen]]
+**use for those AGMP's that are continuous e.g. BIPAP, CPAP, Optiflow . As of May10,2023 only those patients designated as "orange", or "red" require isolation/PPE precautions.  "green" patients have no special precautions. Do not use for one time AGMP's  where there is no other indication for isolation. e.g intubation, bronchoscopy, CPR, nebulizer medications
+<!-- discussed inconsistency with Optiflow being included here but not else; yes it is correct that it is excluded elsewhere and included here - discussed at task. 2022-06-22 -->
 === In the context of [[Colonized with organism (not infected)]] ===
-*If a patient is placed on [[Isolation, infectious]] on arrival '''''only''''' for the reason of pre existing MRSA (or other colonization), then code [[Admit Diagnosis]] [[Colonized with organism (not infected)]] and code the isolation as an [[Admit Procedure]].
+*This code could be either an Admit or Acquired procedure.
+**If it qualifies for the rules of [[Admit Procedure]] then use that.  If not, use [[Acquired Procedure]].
-*For patients who have MRSA in comorbs, and are admitted for other reasons, put [[Isolation, infectious]] in '''acquired''' CCI codes.
+=== Do not use this code for isolation for Use of Cytotoxic Agents ===
+*This is NOT included because such isolation (e.g. keeping pregnant nurses from caring for patients getting certain teratogenic medications) is not isolating the patient.
-{{DiscussTask | For patients who are admitted and have pre existing MRSA to code infectious isolation as an '''acquired''' CCI code is counterintuitive if it is present and treated with isolation on admission. Pre existing colonization would be included as an ADMIT DX if treated with isolation, and the isolation would be included as an admit CCI procedure.
-*I agree, it does feel counterintuitive, but if we are following the WIKI guidelines, it seems like this is how we are supposed to code it. I think their is currently a lot of discrepancy in how this is being coded.
-**there seems to be  confusion all around when to code something as an admit vs acquired vs comorbid. One example we have seen, someone comes in to ICU with stab would injury to heart, has had cardiac arrests, and is in shock.  We see the trauma injury to heart coded as comordid.  Need to discuss collection instruction tweek that would help
-*** Allan recently updated [[Admit Procedure]] with info that is relevant to this. I wonder if the instructions on this page are just a remnant from an earlier iteration of the Admit instructions. As I read the current ones, you would not code this. But yes, good we are taking it to Task... }}
-=== Isolation for Use of Cytotoxic Agents ===
+== Related Code ==
-*This is NOT included because such isolation (e.g. keeping pregnant nurses from caring for patients getting certain teratogenic medications) is not isolating the patient.
+This code is similar to [[Patient is on isolation (TISS Item)]] but collected as a different [[CCI Collection Mode]], so we decided to keep both.
 {{CCI Collection Mode}}
@@ Line 37: / Line 43: @@
 ==Related ICD10 Codes==
 {{Data Integrity Check List}}
+== Data use ==
+* [[Directors Quarterly and Annual Report (Medicine)|Directors Quarterly and Annual Report]]
 == Related Articles ==