Pathogens

The ICD10 buglist contains specific codes for a number of different bacteria, viruses, fungi/yeast, mycobacteria and miscellaneous types of organisms. The entire list can be found in category and subcategories: Template:ICD10 subcat collapsible

Pathogens are coded as their own diagnosis codes:

They are always entered as Combined ICD10 codes with an infection, but not all infections require pathogens. See Infections in ICD10 for more info.

Concerns about Pathogen Coding in ICD10

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?

A. set a limit to pathogen list B. We need to be quite specific in our database in order to properly code VAP criteria, CLI etc. I don’t think the pathogen list for bacteria is extensive enough. No mixed option so would need to put in each pathogen separately. Is Dr Kumar OK with this list?

• SMW

• Cargo

• Categories

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)

What exactly are we taking to steering, then, and has it been added to the agenda? Ttenbergen 22:18, 2018 March 20 (CDT)

• SMW

• Cargo

• Categories

Culture reports

see Lab and culture reports

The Structure of the Pathogen List

• There are categories for: Bacteria, Viruses, Fungi/Yeast, Mycobacteria, and Miscellaneous Organisms
• In what comes below, we must distinguish NOS from unknown.
  • NOS means that we do know the bug, but it's not in our list of specific bugs
  • Unknown means we assume that there IS in fact a bug, but we have no idea about it's actual identity.
• In each of those categories there are a number of specific bugs with their own codes (e.g. B95.3 is Strep pneumoniae)
• But obviously we can't list every bug of any type, so for each of those categories there is also a "wastebasket" code for "NOS". For example, if the bug is a specific bacteria but it's not in our list, then use Bacteria, NOS, etc. These are:
  • Bacteria, NOS
  • Virus, NOS
  • Fungus or yeast, NOS
  • Nontuberculous mycobacteria
  • Infectious organism, unknown
  • Infectious disease NOS OR for buglist organism NOS (when you don't have any idea even what type of bug it is)
    • This code does double duty, and see it's own Wiki page for more information. But it can be used as a pathogen, where it is used when that pathogen is known, but is not included in our list of specific pathogens, and also doesn't fit into one of the other wastebasket categories listed immediately above.
• Separate from these "wastebasket" codes representing when bug is known but not specifically listed, is the situation where it's believed there IS an infection but the bug was not identified at all. This can occur either because no cultures were sent, or those sent were all negative. In this case, use the code Infectious organism, unknown.

Special Codes

• Not an Infection (ICD10 pathogen alternative) - included for cross checks when entering Category:Potential infections

Template:CCMDB Data Integrity Checks

See Infections in ICD10#CCDMB Data Integrity Checks

---

Old coding

The pathogens are a list of possible entries that make up the sub-code for diagnoses categorized as Infection.

• Refer to: UPL - Universal Pathogen List, for a list of "bugs" we track.

• The pathogen subcodes are drawn from the table S_Pathogens table in CCMDB.mdb.

Culture reports (old)

Follow up all culture reports up to 5 days after discharge from unit. If pathogen is still not available then, enter Unknown Pathogen.

Special Codes

• No Culture Sent or Resulted
• Unknown Pathogen

Could someone please fill in specifics about how or when these are to be used? Specifically, if we know specific bugs, are there any that should be coded implicitly even if there are others (ie precedence rules)?

Coding when antibiotics are given but no cultures

If there is evidence of an ongoing infection, even if no further culture code the previous pathogen.

If no culture is sent then we choose the subcode No Culture Sent or Resulted