Pathogens

The pathogens are a list of possible entries that make up the sub-code for diagnoses categorized as Infection. Also referred to as: UPL, Universal Pathogen List. Pathogens are drawn from the S_Pathogens table on your PDA and in the CCMDB.mdb.

Pathogen Table

For the most up-to-date list of pathogens, see your PDA or Diagnosis code book. This is the list as of May 08 and for orientation only.

Special Codes

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)?

59 other Aspiration (early presentation, documented aspiration)

• pahtogen 59 should be used only in conjunction with HAP and CAP
• code code HAP or CAP with a subcode of aspiration, if this is known, as the admission code.
• if the patient subsequently has an organism, code this as a complication (eg. HAP with subcode the organism.)

Discussion

• Can someone confirm for me again when it is appropriate to use code 59 from pathogen table?--MWaschuk 18:25, 2 March 2009 (CST)
• Can someone confirm for me again when it is appropriate to use code 59 form pathogen table (aspiration-early presentation with documentation). Many times it occurs where the pt is in respiratory distress and requires urgent intubation and because there LOC was decreased prior to intubation the physician will document that the pt likely aspirated and cxr will show a new infiltrate or the like. The ETT sample may or may not detect a pathogen. Is this a HAP with subcode 59 or is this a HAP with subcode pathogen detected or negative culture.--MWaschuk 11:26, 16 March 2009 (CDT)
  • Mary-Lou, this topic was discussed with Dan Roberts at a previous meeting. He told us to code HAP or CAP with a subcode of aspiration, if this is known, as the admission code. Then if the patient subsequently has an organism, we are to code this as a complication (eg. HAP with subcode the organism.) Let me know if you have any other questions about this. --LKolesar 13:11, 16 March 2009 (CDT)
    • I have moved Laura's explanation into the actual instructions for code 59. If no one changes that within a week, this discussion can be deleted. Ttenbergen 10:38, 8 May 2009 (CDT)

Mixed results

• 60 mixed mixed bacteria
• 61 mixed mixed bacteria and yeast/fungus
• 62 mixed mixed bacteria with at least one resistant gram negative
• 63 mixed mixed bacteria with at least one resistant gram positive (MRSA, VISA, VRSA, VRE
• 64 mixed mixed resistant bacteria (either 86 or 87) with yeast/fungus

No results

• 65 other Negative Culture
• 92 other No Culture Sent

• Sputums for AFB (Acid Fast Bacilli). As per Dr. Kumar: a negative AFB culture is considered a negative culture and should not to be coded as NO C&S culture sent.--FLindell 15:33, 6 August 2008 (CDT)

Bacteria

• • • g-ve = gram negative
    • g+ve = gram positive
    • R = Rod
    • C = coccus

• Acinetobacter g-ve R
• Actinobacillus actinomycetemcomitans g-ve C-B
• Bacteriods fragilis g-ve R
• Borrelia burgdorferi (Lyme disease)[[1]]

• Campylobacter g-ve R
• Citrobacter diversus g-ve R
• Citrobacter feundii g-ve R
• Clostridium botulinum g+ve R
• Clostridium difficle g+ve R
• Clostridium perfingens g+ve R
• Clostridium tentani g+ve R
• Corynebacterium diphtheriae g+ve R
• E Coli g-ve R
• Enterobacter g-ve R
• Enterococcus faecalis g+ve C
• Haemophlilus influenzae g-ve R C B
• Haemophilus ducreyi g-ve R
• Haemophilus parainfluenzae g-ve R
• Kebsiella pneumoniae g-ve R
• Legionella sp – legionella pneumophilia g-ve R [[2]]

• Listeria monocytogenes g+ve R
• Moraxella catarrhalis g-ve R
• Morganella morganii g+ve R
• Mycoplasma pneumoniae
• Neisseria gonorrhoeae g-ve C
• Proteus mirabilis g-ve R
• Pseudomonas aeruginosa g-ve R
• Salmonella g-ve R
• Serratia g-ve R
• Shigella g-ve R
• Staphylococcus aureus g+ve C
• Staphylococcus epidermidis g+ve C
• Streptococcus agalactiae Group B g+ve C
• Streptococcus pneumoniae g+ve C
• Streptococcus pyogenes Group A g+ve C
• Streptococcus viridans g+ve C
• Treponema pallidum (Syphilis)[[3]]

Fungi

Aspergillus species Blastomyces, Candida, Crytococcus, Histoplasma

Virus

Adenoviruses, Cytomegaloviruses, Epstein-Barr virus, Herpes simplex, Herpes zoster, West Nile

Parasites

Cryptosporidium, Giardia Lamblia, Malaria, Pneumocystis carinii (PCP), Toxoplasma gondii

Discussion / Notes

• will update this list with a table. (trish pending)

Data Integrity Rules

The CCMDB.mdb runs checks for the following:

• no infections without pathogens
• no non-infections with pathogens

For details, see the coding in Access.