Reasoning around moving to ICD10 and our subset of it
This article explains our choice of ICD10 as a coding schema and of the subset of codes we include.
Why are we moving to a new diagnostic coding schema?
Our old diagnosis list was made in-house designed mostly for the Critical Care setting where our database started out. We are moving to a new diagnosis set primarily to make our data set more comparable to other data sets, and to include more diagnoses that are relevant to Internal Medicine physicians outside of the ICU setting.
Why are we moving to ICD10 rather than a different coding schema?
ICD10 is one of the most widely used diagnosis coding standards. It is the diagnosis coding schema used in all hospitals in Canada, including those in Manitoba. Using the same system as used elsewhere means that diagnoses don't need to be translated to another system, where often a 1-to-1 translation is not possible. It also means that our definitions are more likely to be equivalent to those used by other data sets.
Another benefit of moving to ICD10 will be that it should eliminate diagnoses for which we don't have a code, since ICD10 includes codes for diagnoses that have no specific code.
Why are we including the subset of diagnoses that we do
We are seeing increased interest by Internal Medicine physicians in our data set. Since they fund our program to a large extent, we need to make sure our data includes what they are interested in, in a format that is usable for them.
Why are we including some codes that are not part of ICD10-CA
Non-standard ICD10 Diagnoses lists these and provides reasons.
Why do we not include the entire set of ICD10 codes
The full ICD10 includes over 16000 diagnosis codes. We decided to only use a subset of this to make it easier to learn the new list. Any diagnoses whose codes we omitted can be assigned to the next more general NOS code.
Should we remove some?
Some diagnoses such as Alopecia (nonscarring hair loss), Albinism (albino), disorder of the nails do not initially seem significant enough to code. However, they should be retained so that they can be used as comorbidities, especially for medicine patients. For example, albinism is a condition associated with other genetic abnormalities.
Concerns
Pathogen issues
more general coding
Template:Discussion Just leaving this for now so all can check it; this section can be deleted 2018-04-15 or after.
- We have eliminates some of the subspecies and in ICD10 only put them under species only.
- Serratia: no sub categories Serratia species
- Candida: no sub categories Candida species
- Enterococcus: no sub categories - Enterococcus species
- Corynebacterium species: not in list. Old code mapped to: Bacteria, NOS
limit to list?
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From: Rob Ariano - Subject: RE: VAP organisms Sent: Thursday, February 15, 2018 8:32 AM To: Laura Kolesar, Cc: Trish Ostryzniuk Hi Laura, Yes, Dr. Allan Garland had asked me about that; but I hadn’t noticed all the missing ones that you have identified below. I just mentioned that I felt that S.maltophilia should be tracked. Looking at your listing below I would now suggest that we also add: *All Klebsiella - ICD10 reduced to just Klebsiella species *All Serratia - ICD10, reduced to just species *All Citrobacter - ICU10, reduced to just Citrobacter species *All Enterobacter- ICU10, reduced to just Enterobacter species *All Acinetobacter - ICU10, reduced to just Acinetobacter species Those are all important Gram-negative rods causing serious pneumonia as seen in the critical care / infectious diseases literature. ESBL’s are an especially important problem with all Klebsiella species, and Amp-C beta-lactamases have been found commonly with the remaining ones listed above. I would not list Candida, nor Enterococcus. Can you let Allan know that I had not noticed these missing? Thanks,Rob
- Allan agreed we should add these however, we must be careful as the list of pathogen is endless! I do not think we should collect all sub species related to a specific pathogen. For example, we collected Klebsiella oxytoca and pnuemoniae before and any other species was just put under Klebsiella SPP. We will take this to Steering meeting. 18:56, 2018 February 22 (CST)
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What exactly are we taking to steering, then, and has it been added to the agenda? Ttenbergen 22:18, 2018 March 20 (CDT) |
Diagnosis issues
Diagnoses without specific codes missing in ICD10
Diagnoses where it is questionable whether we need them
Please put those right into the offending dxs. That way if we decide to keep them we can put the reason there, and if we decide to remove them we are already there.
APACHE/Charlson in ICD10
- We currently put in a level of severity in our comorbids. Ie COPD- mild, mod or severe. Is it OK to not have this information? Without the severe designation we may miss the chronic history component of apache (severe liver, lung, etc.)
- according to Allan, the ICD10 Codes can be translated to give you Charlson and Apache. Do you have specific concerns? See the following:
Completeness / Do we need to add codes?
- Do we need methamphetamine added?
- ( I recently had this on one of my patients and I ended up using psychoactive substance NOS, chronic abuse/dependence/addiction. When I googled meth, it came up as a psychoactive drug.)--LKolesar 11:52, 2018 February 13 (CST)
- list of pages that need to be updated to mention meth/methamphetamine if we want it coded so. Ttenbergen 19:12, 2018 April 10 (CDT)