COVID-19 (SARS-COV-2): Difference between revisions

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**Also, do not use this to code non-infectious complications or sequelae of COVID-19 -- see '''[[Post COVID-19 condition]]'''

* The majority of COVID Pos patients have myalgias, fatigue, or malaise. We do not collect this as per [[Template:ICD10 Guideline Signs Symptoms Test Results not needed when cause known]]

* As of May 2021, it has become clear that many or most COVID pneumonia patients are also being treated with broad spectrum antibiotics. This is despite evidence that few of these patients actually have superimposed bacterial pneumonia. There are ongoing attempts in Manitoba to get physicians to cease doing this, but it continues to occur. THUS, in someone with proven COVID pneumonia, even if the patient has been placed on antibiotics for possible bacterial pneumonia, you should NOT code bacterial pneumonia UNLESS there is clinical evidence it is present.

**This is different than usual coding of bacterial pneumonia, where a consistent clinical picture + use of antibiotics is sufficient to code it.

**The kinds of "evidence" you should use comes from airway/sputum cultures --- e.g. is a trach culture has lots of WBCs and grows a single organism, this is reasonable evidence (if the team is providing antibiotics). If on the other hand, the trach culture has few or moderate WBCs and grows "mixed oral flora", then this is evidence against superimposed bacterial pneumonia.

**This gets even murkier since many patients have long-term lung infiltrates after COVID pneumonia, which is usually NOT infectious but USUALLY represents pneumonitis and/or fibrosis, but ''CAN'' represent superimposed secondary infection.

**Bottom line on all this is you need to use your judgement, but do NOT code a bacterial pneumonia just because the docs are writing "post-COVID" pneumonia. See below for more info about that.

== Data Collection Instructions ==

@@ Line 20: / Line 20: @@
 **Also, do not use this to code non-infectious complications or sequelae of COVID-19 -- see '''[[Post COVID-19 condition]]'''
 * The majority of COVID Pos patients have myalgias, fatigue, or malaise. We do not collect this as per [[Template:ICD10 Guideline Signs Symptoms Test Results not needed when cause known]]
+* As of May 2021, it has become clear that many or most COVID pneumonia patients are also being treated with broad spectrum antibiotics.  This is despite evidence that few of these patients actually have superimposed bacterial pneumonia.  There are ongoing attempts in Manitoba to get physicians to cease doing this, but it continues to occur.  THUS, in someone with proven COVID pneumonia, even if the patient has been placed on antibiotics for possible bacterial pneumonia, you should NOT code bacterial pneumonia UNLESS there is clinical evidence it is present.
+**This is different than usual coding of bacterial pneumonia, where a consistent clinical picture + use of antibiotics is sufficient to code it.
+**The kinds of "evidence" you should use comes from airway/sputum cultures --- e.g. is a trach culture has lots of WBCs and grows a single organism, this is reasonable evidence (if the team is providing antibiotics).  If on the other hand, the trach culture has few or moderate WBCs and grows "mixed oral flora", then this is evidence against superimposed bacterial pneumonia.
+**This gets even murkier since many patients have long-term lung infiltrates after COVID pneumonia, which is usually NOT infectious but USUALLY represents pneumonitis and/or fibrosis, but ''CAN'' represent superimposed secondary infection.
+**Bottom line on all this is you need to use your judgement, but do NOT code a bacterial pneumonia just because the docs are writing "post-COVID" pneumonia.  See below for more info about that.
 == Data Collection Instructions ==