Influenza in ICD10: Difference between revisions

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*The 4th has a long & weird name:  '''[[Influenza virus NOS -- should almost never be used]]''' (see more info in that article)  
*The 4th has a long & weird name:  '''[[Influenza virus NOS -- should almost never be used]]''' (see more info in that article)  


=== Not Haemophilus or Parainfluenza ===
==Influenza is not Haemophilus influenza (a bacterium) or Parainfluenza (a virus)==
Don't confuse influenza with either of:  '''[[Haemophilus influenzae (H. flu)]]''' OR '''[[Parainfluenza virus]]'''
Don't confuse influenza with either of:  '''[[Haemophilus influenzae (H. flu)]]''' OR '''[[Parainfluenza virus]]'''
*See: [https://en.wikipedia.org/wiki/Influenza#Types_of_virus Wikipedia for types of virus included]
*See: [https://en.wikipedia.org/wiki/Influenza#Types_of_virus Wikipedia for types of virus included]


==Identifying the Presence of Influenza==
==Identifying the Presence of Influenza==
*also used for [[Influenza tracking]]
*It's not always simple.  The reason is that the value of lab tests in helping us figure out whether a person has influenza depends on: (a) how long after onset of symptoms the test was done, (b) which test was done, (c) whether the sample was upper or lower respiratory, and (d) whether the test is done in the midst of flu season, at the start of flu season, at the end of flu season, or not at all during flu season. 


=== confirmed ===
==Our Approach to Diagnosing Influenza==
*'''Lab-confirmed influenza'''
*During established flu season (defined as there has been laboratory-confirmed flu in the community), the diagnosis of influenza is mainly clinical.  So, lab confirmation is '''not''' needed to make the diagnosis.  If the clinical team thinks it’s flu, and they’re treating with a full course of oseltamivir (Tamilfu) or any other anti-influenza agent, then consider influenza as present, regardless of the results of any influenza tests, done in hospital labs or Cadham.
**Present if the ''final'' result of the testing done at Cadham was positive, and absent if not -- regardless of what the clinical team believed.  
*Completely off flu season (warm months, before there is any reported flu in the province, and after the flu season has been declared to be over) -- a person will be diagnosed as having influenza ONLY if the FINAL CADHAM test result is positive. Said another way, in the absence of a positive final Cadham test for influenza, during these time periods we consider influenza as ''absent'', regardless of clinical suspicion, treatment for flu, and rapid test results.
**The tricky part here is that the hospital labs are now doing an influenza test (which is only done on swabs, not on fluid samples, and comes back quickly) PLUS they send the materials on to the Cadham lab were the testing is re-run.  To further muddy the waters, Cadham gives a preliminary result which can be different than their FINAL result. On
*The hard part is right at the start and end of typical flu season.  In this case, use the following algorithm:
{{discussion}}
**One or more lab tests were done (including rapid tests in hospital labs, and Cadham tests) and '''any of them''' were positive -- then consider influenza to be present.
11/21/2017 Allan spoke with the medical director at Cadham (Paul Van Caeseele) who related that the Cadham tests are more sensitive than what's done in hospitals, so that (though it's not 100% perfect) we should consider the '''final''' Cadham result to represent '''the truth''' as regards lab-confirmation of influenza.
**No lab tests were done, but the team says they think it’s flu, and they’re treating with a full course of tamiflu, then consider influenza to be present.
*'''Infection control''':  cases are considered as suspects until we have the final positive Cadham result, not a positive DSM result. - Myna Dyck.


=== suspected ===
*also used for [[Influenza tracking]]
*'''Suspected influenza''' -- here the clinical team wrote believed that it was influenza and gave a “full course” of '''[[Pharm influenza drugs|anti-influenza drug]]''' PLUS either: (a) no lab test was sent at all, or (b) the final Cadham test result was negative.
**For influenza that this not severe, the usual course of oseltamivir (Tamiflu) is 5 days.  But WHO and CDC recommend that in severe cases the drug should be continued until the infection is resolved or there is satisfactory clinical improvement.
{{discussion}}
*We will talk about this more later, and take account of how Infection Control does this.
 
=== How long to wait ===
{{Discussion}}
For those hospitals not using the EPR system for influenza results it will take time(weeks) to track down the hard copy from Cadham. How long do you want us to wait? Outcome will need to live at [[Lab and culture reports]] with link from here so we do this consistently.


== Alternate ICD10s to consider coding instead or in addition ==
== Alternate ICD10s to consider coding instead or in addition ==

Revision as of 16:43, 20 December 2017

ICD10 Codes for Influenza

There are 4 influenza-related codes we're using in ICD10.

Influenza is not Haemophilus influenza (a bacterium) or Parainfluenza (a virus)

Don't confuse influenza with either of: Haemophilus influenzae (H. flu) OR Parainfluenza virus

Identifying the Presence of Influenza

  • It's not always simple. The reason is that the value of lab tests in helping us figure out whether a person has influenza depends on: (a) how long after onset of symptoms the test was done, (b) which test was done, (c) whether the sample was upper or lower respiratory, and (d) whether the test is done in the midst of flu season, at the start of flu season, at the end of flu season, or not at all during flu season.

Our Approach to Diagnosing Influenza

  • During established flu season (defined as there has been laboratory-confirmed flu in the community), the diagnosis of influenza is mainly clinical. So, lab confirmation is not needed to make the diagnosis. If the clinical team thinks it’s flu, and they’re treating with a full course of oseltamivir (Tamilfu) or any other anti-influenza agent, then consider influenza as present, regardless of the results of any influenza tests, done in hospital labs or Cadham.
  • Completely off flu season (warm months, before there is any reported flu in the province, and after the flu season has been declared to be over) -- a person will be diagnosed as having influenza ONLY if the FINAL CADHAM test result is positive. Said another way, in the absence of a positive final Cadham test for influenza, during these time periods we consider influenza as absent, regardless of clinical suspicion, treatment for flu, and rapid test results.
  • The hard part is right at the start and end of typical flu season. In this case, use the following algorithm:
    • One or more lab tests were done (including rapid tests in hospital labs, and Cadham tests) and any of them were positive -- then consider influenza to be present.
    • No lab tests were done, but the team says they think it’s flu, and they’re treating with a full course of tamiflu, then consider influenza to be present.

Alternate ICD10s to consider coding instead or in addition

Template:CCMDB Data Integrity Checks

None yet. Do we need any? Possibly with Template:Discussion

  • caution about putting a cross check with influenza drugs, as there are times when a patient is given the med for suspect influenza however, the Cadham lab report comes back as negative.
    • Best to wait until we have some data to do this. Tina has scheduled review with Julie for 3rd week of November.

Possible checks:

  • if there was a confirmed tmp entry, there has to be a dx
    • maybe no drug and if DC treat or comfort care?
  • if there is a dx... can't do any cross checks in old dx because tracheobronchitis isn't always influenza, right? Might work with the new dxs, though, they are influenza specific
  • if there is a drug... are they ever used for anything else? would coding for influenza go away if lab comes back clean? Might not be able to do anything with the drugs.

Related Articles

Related articles:
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