Infections in ICD10

Infections in ICD10 are coded somewhat inconsistently. There are #Diagnoses where the pathogen is implied and #Diagnoses where the pathogen must be coded separately. #Coding Antibiotic Resistance should also be done when there is one.

Which date to use for infections in Acquired Diagnosis / Complication

• The date we want to use is the date in which the infection first appeared clinically. This can be a very difficult determination, and may include consideration of:
  • Date on which the clinical signs or symptoms first appeared (e.g. fever, or dysuria, etc)
  • Date on which the culture was sent --- but this can be misleading because a culture may not be sent until several days after the symptoms appear.
  • Thus, as usual, you must use your clinical judgment to decide when the infection first showed up.

tangential questions

Untreated positive cultures, in general

• Probably the most common of these is urine and sputum.
• How to code these depends on what the clinical team thinks is true:
  • If they're not treating because they think it's NOT an infection and instead is colonization, then code it as one or the other of: Colonized with organism (not infected) and/or something like Urine tests, NOS, abnormal
  • If on the other hand, they just failed (permanently, or temporarily) to treat what became apparent later to be a real infection, then code it as an infection.

Iatrogenic injuries

• Some iatrogenic codes are self-explanatory for what occurred. For example Iatrogenic, air embolism, as complication of line/infusion/transfusion/injection. But for others, such as Iatrogenic, puncture or laceration, related to a procedure or surgery NOS it's not clear what happened, i.e. what was iatrogenically injured.
  • In these latter cases, with just one exception, DO NOT also code a trauma code for what was iatrogenically injured. This is because iatrogenic injuries are technically not considered to be traumas.
    • that one exception is you should code Rib fracture(s) due to CPR in the context of CPR, cardiac resuscitation.
  • Instead, combine the iatrogenic code with another ICD10 code indicating the body part involved.
    • e.g. for iatrogenic laceration of a pulmonary artery, combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS with Disorder of pulmonary vessels, NOS. See list of NOS codes in ICD10.

Iatrogenic Infection

• These are infections that are related to medical care
  • Most (but not all) are directly related to a medical device that predisposes the patient to infection
  • e.g: ETT, vascular catheters, Foley, suprapubic catheter, implanted ortho devices, implanted cardiac devices, etc, etc.
• For the following three we have specific diagnostic (and attributional) criteria:
  • VAP
  • Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
  • Iatrogenic, infection, urinary catheter
• Also see Nosocomial infection, NOS

Regarding Attribution and Identification of Surgical Wound Infections

• Note that these iatrogenic infections are attributed to the perioperative care for 30 days --- and for ONE WHOLE YEAR if related to an implanted device left in place
• Our reference for this is this (specifically pages 9-10 to 9-14), and describes 4 entities:
  • SUPERFICIAL INCISIONAL SURGICAL SITE INFECTION
  • DEEP INCISIONAL SURGICAL SITE INFECTION
  • ORGAN/SPACE SURGICAL SITE INFECTION -- without an implanted device left in place
  • ORGAN/SPACE SURGICAL SITE INFECTION -- with an implanted device left in place
• For your purposes of whether such an infection is considered a Admit Diagnosis versus Acquired Diagnosis, use the timing rules as above
  • Here is an unusual consequence of this rule for surgical wound infections: Patient has a hip prosthesis put in 8 months ago. Admitted 1 month ago with pneumonia, and today is recognized to have an infection of that hip prosthesis. Despite the fact that the hip infection "seems" to have occurred well after this hospital admission, by the CDC rule it is actually a ORGAN/SPACE SURGICAL SITE INFECTION, and therefore it is attributed to the surgery one year ago, and so you should code it as a Admit Diagnosis even though the recognition of it was delayed for a whole month while in hospital.

Coding Antibiotic Resistance

Antibiotic resistance is combined-coded, see Antibiotic Resistant Organism for more info.

Lab confirmation of results

See Pathogens#Culture reports

Data Integrity Checks (automatic list)

	App	Status
Query check ICD10 Inf Potential Infection must have pathogen or alt	CCMDB.accdb	declined
Check Inf Antibiotic resistance must have pathogen or Infection with implied pathogen	CCMDB.accdb	implemented
Check Inf Infection with implied pathogen must not have a pathogen combined code	CCMDB.accdb	implemented
Query check ICD10 Inf Infection req Pathogen must have one	CCMDB.accdb	implemented
Query Check Inf Pathogens must have Infection requiring pathogen or Potential Infection	CCMDB.accdb	implemented