Significant complications

Significant complications tracked on medicine units.--TOstryzniuk 20:35, 24 November 2009 (CST)

• NOTE:Dr.Dan Roberts had previously provided this list of “specific complications” that he wanted to track on medicine wards. --TOstryzniuk 20:48, 23 November 2009 (CST)

• Complication/acquired DX code:

1. Central Line complication (requires transfusion or surgery)

• • 86000 - Central Line Related Blood stream Infection (CLR-BSI) (see UPL for subcode 1-95 - not all subcodes apply and we have no rules to exclude any)
  • 98003 Pneumothorax – 2nd to central line insertion
  • 98102 Hemothorax – 2nd to central line insertion
  • 98201 Significant bleed - 2nd to central line - Femoral Artery/vein
  • 98203 Significant bleed - 2nd to central line - Pulmonary Artery
  • 98203 Significant bleed - 2nd to central line - subclavian arter/vein
  • 98205 Significant bleed - tamponade 2nd to central line

• • 98300 Stroke due to central line
  • 98500 Ischemia 2nd to central line (swan ganz, IJ, Subclavian)
  • 98900 Loss or broken guidewire with central line insertion
  • 99000 Arterial insertion of venous central line (malpositioning of PA or IJ into carotid artery or LV).

2. DVT Art/Ven Embolus/Thrombus -do you just want just lower extremity DVT or any other type?

• • 13200 (code by itself is mixed bag of Arterial or venous embolus or Thrombus)
  • 13201 Femoral (lower extremity)
  • 13202 Popiteal (lower extremity)
  • 13203 Subclavian (upper extremity/thorax-armpit, collar bone area)
  • 13204 Superior mesenteric (abdomin)
  • 13205 Post Operative (anywhere in body)
  • 13206 Internal Jugular (upper extremity/thorax –neck area)
  • 13208 Axillary (upper extremity/thorax-armpit - collar bone area)
  • 13209 Innominate (upper extremity/thorax -)

• • • 13606 aortic – Excluded because this is generally a paradoxical embolization of DVT thrombus into the aorta. Our code is a mixed bag of arterial venous embolus or thrombus so don’t include for DVT.

3. Ulcers - Decubitus only

• • 94500 Decubitus ulcer only (used without subcode if stage unknown)
  • 94501 stage 1 surface reddening
  • 94502 just under skin
  • 94503 deep to muscle
  • 94504 full layer to bone

4. HAP-Hospital Acquired Pneumonia

• • 3800 (UPL subcodes 1-95 (exclude subcode 59, see below))
  • 3600 (UPL subcodes 1-95 (Pneumonia if not sure if hosp or community acquired, exclude subcode 59))

5. Aspiration Pneumonia Aspiration (early presentation, documented aspiration)

• • 3859 hospital acquired aspiration pneumonia
  • 3659 aspiration pneumonia not sure where acquired

• • Why are collectors using 3659 in acquired complication slot? 3659 is aspiration pneumonia (where it occurred is not known). If it occurred after unit admission and is in the complication DX slots then it should be 3859 (Hospital acquired aspiration) should it not? --TOstryzniuk 11:50, 25 November 2009 (CST)
    • I agree that the pneumonia 3600-59 should only be used if you don't know on admission to your ward when the aspiration occured, after admission to your ward any pneumonia occuring would be HAP-aspiration.--Gail Hall.

• • I agree that if the peumonia is in the acquired complications it should be coded as a HAP or VAP but I wouldn't mind clarification on when it is appropriate to use 59 (asp early presentation) as a subcode. Often the physician will write asp pneumonia because of decreased LOC or dysphagia as a cause. Is this how you would like us to use code 59? Or would like us to code HAP with either code 92 (culture not sent) or 65 (negative culture) or the actual organism that grows which ever is the case and not code 59 even if it appears the pt did aspirate due to decreased LOC?--MWaschuk 14:36, 26 November 2009 (CST)
  • This was explained. Please click on the link for more information: Aspiration (early presentation, documented aspiration).TOstryzniuk 14:42, 26 November 2009 (CST)

6.Pulmonary Embolus

• • 1300 Pulmonary Embolus (used without subcode if reason is unknown)
  • 1301 Pulmonary Embolus- Septic
  • 1302 Thrombic
  • 1303 Post Operative
  • 1304 Air
  • 1305 Post Trauma-fat emboli – not included for medicine
  • 1390 other reason (same as using 1300 when reason is unknown)

7. Cardiac Arrest

• • 10001 Unwitnessed Cardiac Arrest
  • 10002 Witnessed Cardiac Arrest

8. CVA-Cerebral Vascular Accident

• • 50501 CVA Post angiogram
  • 50502 CVA Post operative procedure
  • 50504 CVA Post anticoagulation therapy
  • 50505 CVA Intra-operative
  • 50506 CVA Post Partum
  • 50590 CVA 2nd to other causes (original description in "other medical proedures)
  • 98300 CVA due to central line (also see Central line complications)

9. NG tube placement problems

• • 99101 Aspiration due to Malpositioning

10. Septic Shock

• • 4400 (UPL subcode 1-95)

11. Severe Sepsis

• • 4500 (UPLsubcodes 1-95)

12. Septicemia/Bacteremia/Fungemia

• • 4600 (UPL subcode 1-95)

13. Cystitis (Bladder Infection)

• • 5100

14. Esophagitis 2nd to infection

• • 6400 (UPL subcode 1-95)

15. Gastroenteritis

• • 6500 (subcode 1-95)

16. Neutropenic Enterocolitis

• • 6800 (UPL subcode 1-95)

17. Pseudomembranous Colitis (C-DIFF)

• • 7212

18. Post OP Surg Wound Infection

• • 8300 (UPL subcode 1-95)

19. Soft tissue abcess

• • 8400 (UPL subcode 1-95)

20. Soft Tissue Infection (includes Cellulitis)

• • 8500 (UPL subcode 1-95)

21. Ulcers - Lower Extremity & other

• • 94700

22. Tracheostomy (complications)

• • 77404 obstruction
  • 77405 malpositioning
  • 77406 bleeding (significant)
  • 77407 Fistula formation
  • 77408 site infection
  • 77490 any other complications

23. Pneumothorax (2nd to procedures)

• • 98001 2nd to pleural tap/thoracentesis
  • 98002 2nd to chest tube insertion
  • 98003 (see item #1 above - central line complication)
  • 98090 2nd to other procedures

24. Hemothorax (2nd to procedures)

• • 98101 2nd to pleural tap/thoracentesis
  • 98102 (see #1 above - central line complication)
  • 98103 2nd to chest tube insertion
  • 98190 2nd to other procedures

25. Mainstem intubation

• • 98600

26. Aortic dissection post angioplasty

• • 98700

27. Liver laceration post procedure (post chest tube or any other procedure)

• • 98900