Template:ICD10 Guideline Iatrogenic: Difference between revisions

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=== Iatrogenic codes ===
=== Iatrogenic Infection ===
*We will consider a diagnosis to be iatrogenic if it is related to:
*These are infections that are related to medical care
**A device -- e.g. a UTI in a person with a Foley
**Most (but not all) are directly related to a medical device that predisposes the patient to infection
**A procedure -- e.g. hemorrhage related to a surgery
**e.g:  ETT, vascular catheters, Foley, suprapubic catheter, implanted ortho devices, implanted cardiac devices, etc, etc.
**A medical intervention -- e.g. anaphylactic shock occurring after giving a normal dose of a pharmaceutical
*For the following three we have specific diagnostic (and attributional) criteria: 
*As always, the determination that the device, procedure or medical intervention was "related" to the new (iatrogenic) diagnosis may often involve judgement.
**[[VAP]]
*BUT we will NOT code a problem as specifically iatrogenic if it's not related to a device, procedure or medical intervention, and is instead simply something that occurred after admission.  For THOSE you'll just code them as '''[[Acquired Diagnosis]]'''.  Example is a person who gets a UTI in hospital but has not had urinary catheter recently.
**[[Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)|Iatrogenic, infection, central venous catheter-related bloodstream infection]]
**[[Iatrogenic, infection, urinary catheter]]
 
 
=== Regarding Attribution and Identification of Surgical Wound Infections ===
*Our reference for this is:  [https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/surgicalsiteinfectionsurveillance/casedefinitions/File,3058,en.pdf CDC Surgical Wound Infection Guidelines]
*These guicelines cover the following 4 entities:
**SUPERFICIAL INCISIONAL SURGICAL SITE INFECTION
**DEEP INCISIONAL SURGICAL SITE INFECTION
**ORGAN/SPACE SURGICAL SITE INFECTION -- without an implanted device left in place
**ORGAN/SPACE SURGICAL SITE INFECTION -- with an implanted device left in place
*Note that these types of iatrogenic infections are attributed to the perioperative care for 30 days --- and for ONE WHOLE YEAR if related to an implanted device left in place
**For your purposes of whether this infection is considered a [[Admit Diagnosis]] versus [[Acquired Diagnosis]], use these rules.
**Here is an unusual consequence of this rule for surgical wound infections:  Patient has a hip prosthesis put in 8 months ago.  Admitted 1 month ago with pneumonia, and today is recognized to have an infection of that hip prosthesis.  Despite the fact that the hip infection "seems" to have occurred well after this hospital admission, by the CDC rule it is actually a ORGAN/SPACE SURGICAL SITE INFECTION, and therefore it is attributed to the surgery one year ago, and so you should code it as a '''[[Admit Diagnosis]]''' even though the recognition of it was delayed for a whole month while in hospital.

Revision as of 12:29, 4 December 2018

Explanation of use of iatrogenic codes


Iatrogenic

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Iatrogenic Infection


Regarding Attribution and Identification of Surgical Wound Infections

  • Our reference for this is: CDC Surgical Wound Infection Guidelines
  • These guicelines cover the following 4 entities:
    • SUPERFICIAL INCISIONAL SURGICAL SITE INFECTION
    • DEEP INCISIONAL SURGICAL SITE INFECTION
    • ORGAN/SPACE SURGICAL SITE INFECTION -- without an implanted device left in place
    • ORGAN/SPACE SURGICAL SITE INFECTION -- with an implanted device left in place
  • Note that these types of iatrogenic infections are attributed to the perioperative care for 30 days --- and for ONE WHOLE YEAR if related to an implanted device left in place
    • For your purposes of whether this infection is considered a Admit Diagnosis versus Acquired Diagnosis, use these rules.
    • Here is an unusual consequence of this rule for surgical wound infections: Patient has a hip prosthesis put in 8 months ago. Admitted 1 month ago with pneumonia, and today is recognized to have an infection of that hip prosthesis. Despite the fact that the hip infection "seems" to have occurred well after this hospital admission, by the CDC rule it is actually a ORGAN/SPACE SURGICAL SITE INFECTION, and therefore it is attributed to the surgery one year ago, and so you should code it as a Admit Diagnosis even though the recognition of it was delayed for a whole month while in hospital.
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