Influenza in ICD10

ICD10 Codes for Influenza

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

• 3 code are for actual disease due to influenza:
  • Influenza pneumonia
  • Influenza without pneumonia but with other respiratory manifestations
  • Influenza with nonrespiratory manifestations
• 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

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

• See: Wikipedia for types of virus included

Identifying the Presence of Influenza

• also used for Influenza tracking

confirmed

• Lab-confirmed influenza
  • Present if the final result of the testing done at Cadham was positive, and absent if not -- regardless of what the clinical team believed.
  • 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

Template:Discussion 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.

• Infection control: cases are considered as suspects until we have the final positive Cadham result, not a positive DSM result. - Myna Dyck.

suspected

• Suspected influenza -- here the clinical team wrote believed that it was influenza and gave a “full course” of 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.

• We will talk about this more later, and take account of how Infection Control does this.

How long to wait

Template: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

• Haemophilus influenzae (H. flu)
• Parainfluenza virus

Template:CCMDB Data Integrity Checks

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

• Influenza virus
• Pharm influenza drugs
• Dxs
  • old: Tracheobronchitis
  • new (see above)

• 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.