Allan's links

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Allan offered to help us out with the ICD10 documentation. Here are a few links to get started.

specific questions for Allan

Add to this by adding the following to the article:

{{Discuss | who = all, Allan, ... | question = 
* <put your concern here>}}

Automatically generated list

  • current # of questions: 36
edit page question
edit Colonized with organism (not infected)
  • Are all of these actually things that can colonize without infection? We should only list those here that can. I started adding in links but then decided to hold off in case a lot of them drop off this list. Ttenbergen 15:34, 2018 November 28 (CST)
  • The above list is those organisms that require isolation. You may want to move this list to the Isolation, infectious section.--LKolesar 07:06, 2018 December 24 (CST)
edit Guideline for coding organ donation after death
  • I had one patient where they withdrew care in the unit then went directly to the OR to harvest the organs. What do we do in this case?--LKolesar 08:03, 2019 June 5 (CDT)
edit Organ donor (organ/tissue donation by the donor)
  • If I understand Guideline for coding organ donation after death right we will not actually be coding Organ donor (organ/tissue donation by the donor) for deceased patients , since that will always happen elsewhere, and pt won't come back to us after, so not our dx. If I understand that right we should probably put a one-liner here to make that clear since it's a bit counter-intuitive. And likely at that page as well.
  • What date in the Acquired Diagnosis do you put for this code? Do you use the date that they decide the pt will be an organ donor? Or would you prefer the date the patient goes to the OR (which would be the same as the discharge date?
    • These patients go to a different ward after transplant, right? So we would likely not currently track the CCI for this. Maybe transplants are something we should track if they are at the end of stay. I'll flag this for Allan.
      • I am referring to an organ donor (not a transplant recipient). Most donors go to the morgue after donating their organs in the OR. I am not asking about CCI, just the date for the acquire ICD10 code. I am not sure who wrote the above comment.
edit Task Team Meeting - Rolling Agenda and Minutes 2019
  • Minutes from June 12 Task meeting - to be posted
edit Query check ICD10 mechanism vs trauma
edit Guideline for coding organ donation after death
  • People have expressed concern about the that there might be significant interventions listed on TISS in the time between Brain death and pt leaving the unit; will we continue to do TISS for this, and how will TISS scores for this time affect any reporting? If we exclude the time from LOS it will mess with the N for this.
edit Guideline for coding organ donation after death
edit 24 Hour Intensivist Presence: A Pilot Study of Effects on ICU Patients, Families, Doctors and Nurses
  • how did the database program support this publication?
edit Antibiotic Resistant Organism
  • It is awkward to work with/find readily available specific information as to the antibiotics included in the general antibiotic resistant

articles. Some articles include links to sites that may/may not be that helpful in determination of inclusion antibiotics.

  • Would it be possible to include a listing of common antibiotics in the general antibiotic resistant articles? It would be helpful for collectors to

have an inclusion list in those articles to use as a quick and easy reference. p:Pam Piche

    • Pam Piche: Question from Allan: I'm not quite sure what you're asking here. Is it which antimicrobials are for which type of bug (bacteria, fungal, etc), or something else?? Please expand on your question.
    • I was thinking along the lines of a listing of inclusion antibiotics such as is available in ICU Pharm flow tab (when hovering over category). I was wondering if such a listing would be helpful in quick determination of inclusion antibiotics?
edit Guideline for coding organ donation after death
  • Julie, which reports and what linking will be affected by this, so we can update the related wiki pages?
    • Firstly, Medicine is the only one which report linked admissions during a hospitalization. If a medicine patient happens to go to an ICU, died, an organ donor and move to another ICU , this rule is saying do not consider the second ICU. what will be the LOS of that hospitalization - I presume this rule will exclude the second ICU stay, is that correct?
edit Physical rehabilitation care
  • what is cardiac rehab and does this mean most STB CICU should automatically be applying this code for most patients even if it is standard orders for care?
edit Pneumonia, ventilator-associated (VAP) As you are likely aware, it is important to establish a specific incident date for a VAP. When a VAP swoop is done, the chart is audited for VAP bundle compliance during the previous 72 hours of patient care.
  • Before this new criteria was implemented, we used the date the culture from the ETT was sent and was positive for a pathogen. I think we need to have clear guidelines as to which date to choose now with the new criteria. The options are:
    • 1.Date when all criteria are met.
    • 2.When all criteria are met except the CXR if the CXR was done later.
    • 3.At first evidence that a potential VAP is brewing. (eventually does meet all the criteria).
  • We would appreciate your expertise in determining what is best. I will forward your recommendations to the VAP committee here and we should have it written into our wiki criteria as well. Thanks so much! Laura, as per email to Allan- May 16.19
edit Admit Diagnosis Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review
edit Comorbid Diagnosis Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review
edit Template:ICD10 Guideline Como vs Admit Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review
edit S ICD10 Charlson Como patterns table Como Admit Acquired Primary Limits - this is part of that discussion - if we want to limit some of these to not being allowed as admits, it will likely have to be done here.
  • AG REPLY --- yes we can and should go through ALL ICD10 codes and indicate which of the 3 Dx Types they're allowed in (ie deal with Controlling Dx Type for ICD10 codes). AG needs to be reminded to deal with this around June 2019
edit Check ICD10 some cant be primary Como Admit Acquired Primary Limits - Category:Mechanism would need to be excluded as well, and so would past history, and quickly the list gets so large again that we are back at discussing Controlling Dx Type for ICD10 codes where we should simply include "Primary"-ability.
  • AG OBSERVATION --- we will just take care of this when we take care of Admit/Comorbid/Acquired
edit Controlling Dx Type for ICD10 codes Como Admit Acquired Primary Limits / Dx grouping - this is part of both of those discussion
  • I have emailed Allan the table with all Dxs to set them as Como_allowed, Admit_allowed, Acquired_allowed. Will set up infrastructure to contain this once I have data. Ttenbergen 12:31, 2019 February 13 (CST)
    • Ignore until at least April.
edit S ICD10 APACHE Dx patterns table dx grouping

if you have a reference, ideally online, for what you used to make the APACHE comorbid ranges, please add it here.

  • AG NOTE TO SELF -- you have to go through and confirm the ICD10/CCI codes to automatically code for the AP2 comorbs
edit S AP Chronic Dx grouping
edit LOS Medicine per ward stay Hi Dr. Garland,A thought came up after the last Task meeting related to the discussion on using Service LOS vs. Physical bed LOS (location). We also have A/D/H service patients go to the ward D5. This ward is typically less acute and patients will transfer to D5 from all of the medicine wards (A4/H4/D4/B3/H7). The patients retain their service (A/D/H) while they are on D5, some patients will switch attending (to the D5 Attending), others will stay with the same Attending they had prior to arrival on D5, but the service will remain the same. The Attendings on D5 do not have a specific service and, there is no rule as to which patients switch to the D5 attending. Some patients will be discharged from D5 still under the same Attending that cared for them prior to arrival on D5. When patients leave A4/D4/H4/B3/H7 their profiles are completed (discharged) by the designated ward collector and a new profile is created by the D5 collector.Thanks, Val Penner, May 16.19
edit Effects on patients, physicians and families of 24 hour, on-site intensivist coverage in academic and community ICU care how did we support this publication?
edit Blood Product Data I have made this page to document progress toward this import.
edit Pneumonia, ventilator-associated (VAP) Is the following only for the immunocompromised patients, or for all?
edit Stimulants incl. methamphetamine, poisoning This is categorized both as Iatrogenic and as poisoning by non-pharmaceuticals - seems inconsistent. Meth would be non-pharm maybe, but other stimulants might (?) be iatrogenic, so maybe this is right. Just confirming.
edit Bacteremia This lists in Apache Neuro because it is in the following range:

Nonop - Large categories - Neuro NOS - A17. - A69.22

When we touche on this at an Allan's list meeting you agreed that probably wasn't right.
edit Bed borrow we want to unify this concept; started discussion today Ttenbergen 14:33, 2019 April 9 (CDT)
  • we are seeing at Grace, a number of patients that are admitted from a GRA ward into the GRA ER under ICU care until bed is available in Grace ICU. Unlike CON or OAKs, that if patient needs ICU, and no bed, they go to ER, under ER service care until ICU bed available. At Grace, this is a bed borrow by ICU service in ER dept, but our TMP project does not have to ITEM for GRA ER for this purpose. As discussed in Task, we will likely be seeing more of this and we need to find out if ICU would like to know how much time patients spends in ER like this. We need to decide how we are going to capture this.
  • GRA_MICU-10422
  • GRA_MICU-10458
  • UPDATE: on May 2.19 we added GRA ER as item in TMP for Project Borrow arrive. At a later time we also added GRA_MICU
  • UPDATE: June 12.19 - planned changes - not yet active - Off ward loc
edit Guideline for coding organ donation after death What are the instructions for this? Would they go through the exercise of declaring such a patient's Brain death or would we capture them as Acquired Diagnosis MAID and Dispo "Death - to OR" or more problematically "Death - to other ICU" ?
edit ICUotherService When a CICU pt is in MICU under MICU service we do not have an option in the drop down for this (this occasionally happens when they have no beds). We also do not have an option for an MICU pt in CICU under CICU service (although I do not know if this ever happens but I suppose it could happen).--LKolesar 14:02, 2019 May 3 (CDT)
edit Organ donor (organ/tissue donation by the donor) Why would it not be an Acquired Diagnosis? They may have been admitted for Preparatory care (incl preop optimization), no? Or would they then not be on a ward where we collect because we are not surgical?
edit Query check ICD10 ESRD and AKI only if transplant Would the past history really allow for this? i think only a CCI makes it OK to have both an ESRD and an AKI dx in same patient.
edit Transition to Database Server You were going to follow up with the new CHI person to make sure they are aware.
edit Iatrogenic, thromboembolism, as complication of line/infusion/transfusion/injection _q
  • I have had a few patients with a thrombus in their lines and also in veins related to line insertions. I wanted to use this code but does this include just the thrombus or does it have to be a thromboembolism?--LKolesar 12:33, 2019 May 13 (CDT)
edit Severe sepsis _q
  • What is the definition of "organ failure" as it pertains to severe sepsis? For example, is an acute rise in Cr (AKI) enough to meet the definition or does the patient have to be on dialysis? Could we have some criteria for the failure of different organs? --Jvelasco 15:32, 2019 May 21 (CDT)
edit Hypokalemia, severe or symptomatic _q Are we supposed to enter this only once per admission, or every time this occurs? Some patients will have multiple days in which their electrolytes will meet these criteria. This question applies for other imbalances, such as magnesium, sodium, phosphate...Mlagadi 09:19, 2019 May 1 (CDT)
edit Task Team Meeting - Rolling Agenda and Minutes 2019 _q Which dx is this about, so we can add it to the page? Ttenbergen 13:00, 2019 June 13 (CDT)
edit Hypertension, malignant _q2
  • I would like to submit the following definition for peer review and discussion for Malignant Hypertension. Malignant Hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. "Normal" blood pressure is <140/90. A person with Malignant Hypertension has a BP typically >180/120 --mvpenner 11:02, 2015 April 15
    • had a brief look at https://en.wikipedia.org/wiki/Hypertensive_emergency and it looks like additional things need to be present to define as hypertension. would you be OK if we just linked to there as we do fro many articles? Ttenbergen 15:27, 2015 April 15
      • Thank you!--mvpenner 06:04, 2015 April 16
        • Does that mean you agree that adding a link would be a solution/improvement? Ttenbergen 17:39, 2015 April 16
          • Thank Tina. I agree with posting the link, but also see benifit in having a brief summary in the definitions.--mvpenner 07:56, 2015 April 20 (CDT)
            • Sure, but it needs to include all the relevant parts. From reading the wikipedia entry I didn't think the one you proposed would. Could someone more medical weigh in? I am just looking at it from a consistency angle... Ttenbergen 13:55, 2015 April 20
            • I think the abbreviated definition is clear and helpful. More info would probably make it less readableMlagadi 15:13, 2019 May 14 (CDT)
              • I absolutely agree that any additional text makes is extra text to read ;-) but I want to make sure we don't leave out something vital. I'll leave this on Allan's list for now, hopefully we can get an answer at our next meeting.
edit Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic _q2
  • This specific kidney code states it is "unspecified as acute or chronic". I tried to use this code to hook up to make a uremic pericardial effusion/ pericarditis but I get the error message because this is a Stage 5 CRF patient. Because this code is unspecified I think it should be allowed to use it in this case unless there is a better option for chronic uremia causing pericarditis and effusion. Need advice on this. --LKolesar 11:52, 2019 May 6 (CDT)
edit Physical rehabilitation care _q2
  • why are we collecting this type of intervention, for what purpose and when should this be coded as a significant acquired DX problem? It is showing up in STB_CICU as one of the most common acquire codes? Is this not part of standard orders for care for post surgical pts? Some are applying this code when physio comes to see pts, others are would use this code if it is a significant reason impacting LOS. We are not consistent to be looking in charts if physio came and did the work or not. --Julie and Trish. * I agree, most surgical patients get physio consults. Is it important to track who gets physio consults or is this also for nurses who provide physical rehab care or is this for occupational therapy?? We have chest physio on the tiss. To me this is not a diagnosis and am wondering why it is even in the ICD 10 codes.--LKolesar 07:44, 2019 May 7 (CDT)
edit Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS _q2 CCMDB is giving an error message saying "has trauma mechanism but no related trauma", cannot send - Joanna Velasco May 29, 2019
edit Mechanism of injury: other NOS _q2

How are we supposed to code injuries sustained from an assault not involving a weapon?? Would it be this code in this article(Mechanism of injury NOS), or Mechanism of injury: struck by an inanimate moving object/blunt trauma?--Mlagadi 09:55, 2019 June 3

  • so was person assaulted by punches/kicks? If so, a fists or feet are not inanimate objects, therefore.....Allan, what is the mechanism to be used. Staff are having trouble fitting clear issues into some slot.
edit Artificial openings NOS care _q2 Very possibly we should eliminate this code as CCI code is better ?!?!?
edit Parasitic infection, NOS _q2 This code requires a pathogen, however there is a very short list for parasitic pathogens and this is the only option for a parasite that is not on the list. For example trichomonas. I think we should be able to put this option without a specific pathogen as it should be implied. --LKolesar 13:19, 2019 May 6

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