Template:ICD10 Guideline Iatrogenic: Difference between revisions

Revision as of 13:38, 27 November 2019

Explanation of use of iatrogenic codes

Some iatrogenic codes are self-explanatory for what occurred. For example Iatrogenic, air embolism following infusion, transfusion or injection. But for others, such as Iatrogenic, puncture or laceration, related to a procedure or surgery NOS it's not clear what happened, i.e. what was iatrogenically injured.
- In these latter cases, with just one exception, DO NOT also code a trauma code for what was iatrogenically injured. This is because iatrogenic injuries are technically not considered to be traumas.
  - that one exception is you SHOULD code Rib, fracture, injury/trauma in the context of CPR, cardiac resuscitation.
- Instead, combine the iatrogenic code with another ICD10 code indicating the body part involved.
  - e.g. for iatrogenic laceration of a pulmonary artery, combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS with Disorder of pulmonary vessels, NOS.

These are infections that are related to medical care
- Most (but not all) are directly related to a medical device that predisposes the patient to infection
- e.g: ETT, vascular catheters, Foley, suprapubic catheter, implanted ortho devices, implanted cardiac devices, etc, etc.
For the following three we have specific diagnostic (and attributional) criteria:
Also see Nosocomial infection, NOS

Note that these 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
Our reference for this is: CDC Surgical Wound Infection Guidelines, and describes 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
For your purposes of whether such an infection is considered a Admit Diagnosis versus Acquired Diagnosis, use the timing rules as above
- 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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 </noinclude>=== Iatrogenic injuries ===
-For iatrogenic injuries we do not want to include a trauma code for what was actually injured. We realize that this means we will loose detail in that case.
+*Some iatrogenic codes are self-explanatory for what occurred.  For example '''[[Iatrogenic, air embolism following infusion, transfusion or injection]]'''.  But for others, such as '''[[Iatrogenic, puncture or laceration, related to a procedure or surgery NOS]]''' it's not clear what happened, i.e. what was iatrogenically injured.
-'''The only exception to this is [[Rib, fracture, injury/trauma]] in the context of [[CPR, cardiac resuscitation]].
+**In these latter cases, with just one exception, DO NOT also code a trauma code for what was iatrogenically injured. This is because iatrogenic injuries are technically not considered to be traumas.
-{{DA | 1
+***that one exception is you SHOULD code [[Rib, fracture, injury/trauma]] in the context of [[CPR, cardiac resuscitation]].
-You wanted a link to remind you to link with disorder NOS instead of trauma, or similar. }}
+**Instead, combine the iatrogenic code with another ICD10 code indicating the body part involved.
+***e.g. for iatrogenic laceration of a pulmonary artery, combine:  '''[[Iatrogenic, puncture or laceration, related to a procedure or surgery NOS]]''' with '''[[Disorder of pulmonary vessels, NOS]]'''.
 === Iatrogenic Infection ===