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

edit page question ModDate
edit page question ModDate
edit Antibiotic Resistant Organism
  • Allan has agreed to add a list to the relevant drugs to the difference resistance pages
  • 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?
 2019-10-10 3:56:06 PM
edit Iatrogenic codes in ICD10
  • The instruction for HAP is different here than the Hospital-acquired pneumonia (HAP) in ICD10 page.--Jvelasco 07:56, 2019 July 16
    • this spot here should probably just be a link to that other page, with coding details living there only. Otherwise these will just get out of sync again. Ttenbergen 12:52, 2019 July 18 (CDT)
    		•  2019-07-18 5:52:48 PM
    edit Severe sepsis
  • 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)
  • AG INFO: This is a very hard issue that everybody around the world is struggling with. The SEPSIS-3 guidelines operationalizes it by defining it as a certain rise in SOFA score from baseline. BUT it's not a very good clinical definition because obtaining the baseline sofa data is a lot of work. So I'll contemplate this.
    		•  2019-09-12 9:45:18 PM
    edit Severe sepsis
  • 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)
  • AG INFO: This is a very hard issue that everybody around the world is struggling with. The SEPSIS-3 guidelines operationalizes it by defining it as a certain rise in SOFA score from baseline. BUT it's not a very good clinical definition because obtaining the baseline sofa data is a lot of work. So I'll contemplate this.
    		•  2019-06-20 3:16:40 PM
    edit Depression (major depressive disorder, recurrent depression)
  • Why wouldn't we use the code Depressive episode without major depressive disorder if it was an acquired or admit diagnosis? Where does that fit in? -Michelle Lagadi, July 15.19
    		• 2019-07-24 8:10:43 PM
    edit Query check ICD10 chronic vent acute resp failure 1ChronicVent
  • Question from Joanna: "Question for you… I have a patient on chronic vent at home. He develops a raging pneumonia and has to be admitted to ICU in respiratory failure. I combined the Chronic dependence on mechanical ventilator code with Pneumonia, NOS and Respiratory failure (insufficiency) NOS, acute, but I’m getting the following cross check error when I try to check off the diagnosis box:" (link to this page): Patient has a chronic vent code and an acute respiratory failure, which should not be happening in same pt.
    • I think this is more of a “how do we want to code and report this” question than a cross check question. Do we want to be able to code chronic vent with acute failure in some circumstances? If so, what are those circumstances. Or are they so complicated that we just need to abandon this check?
  • AG REPLY --- I feel your pain. Since we DO want this crosscheck, the best solution is to remove the resp failure code here, and IF YOU WANT (not required) in it's place code the aspect of resp function that is now worse, e.g. Hypoxemia (hypoxia)
    		•  2019-10-10 4:04:59 PM
    edit Chronic dependence on mechanical ventilator 1ChronicVent Need better definition to include the possibility of chronic before acute. 2019-10-10 4:05:22 PM
    edit Controlling Dx Type for ICD10 codes Como Admit Acquired Primary Limits 1/ 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)
      • Allan won't have a chance to review until at least mid Sept 2019
    		 2019-10-04 4:07:08 PM
    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 2019-09-22 4:45:28 PM
    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 2019-02-13 7:20:47 PM
    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 2019-09-18 3:37:08 PM
    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
    		•  2019-04-30 1:52:12 PM
    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
    		•  2019-09-22 4:44:08 PM
    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
    But mainly I used this ref: https://rstudio-pubs-static.s3.amazonaws.com/231351_940f14aa51a6427a9e92d5a04daefc3e.html    		 2019-07-24 4:56:25 PM
    edit S AP Chronic Dx grouping 2019-09-22 5:02:13 PM
    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 2019-05-16 9:00:13 PM
    edit Blood Product Data I have made this page to document progress toward this import. 2019-03-09 11:28:40 PM
    edit Aborted Procedure I have to find a CCI code for a patient who was given cardiac anaesthesia for a scheduled aortic valve replacement, but upon TEE intraop, was found to not need the procedure. She was brought to ICCS for recovery, weaning & extubation 2019-08-08 10:40:13 PM
    edit Deceased patients I needed clarification on this. I recently had a patient that was sent for a coronary angio, who arrested and died during the procedure. At the time, I was told that my dispo field should be the coronary cath lab, and to not code the angio or any complications that arose from it. The above statement seems to contradict thisMlagadi 07:44, 2019 August 29 (CDT) 2019-10-03 9:26:03 PM
    edit Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS q_iatrogenic_trauma

    CCMDB is giving an error message saying "has trauma mechanism but no related trauma", cannot send - Joanna Velasco May 29, 2019

    • AG REPLY -- the issue is that this is not a trauma that requires a cause. TINA our soln is to turn all the iatrogenic things like this into "Potential Mechanisms"
    		 2019-10-04 10:09:37 PM
    edit Query check ICD10 mechanism vs trauma q_iatrogenic_trauma This is the query that is what is causing trouble with entries like fractures during CPR etc. For now the check makes no allowance for iatrogenics. 2019-10-04 10:09:21 PM
    edit Encephalopathy, toxic Some parts of the following should probably go back in there, emailed Allan.

    incl drug-induced (also code drug if known) except

    		2019-09-17 3:17:15 AM
    edit Pneumonia, ventilator-associated (VAP) There is often a difficulty in trying to apply this criteria in the neuro population, as they will have elevation in both T and WBC for very long periods which are not related to infection, and obviously already have a change in LOC. How should we deal with this issue? (Joyce) 2019-07-31 3:29:49 PM
    edit Bacteremia This lists as Apache Neuro and is in APACHE Acute Dxs in ICD10 codes because it is in the following range:

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

    When we touched on this at an Allan's list meeting you agreed that probably wasn't right. Emailed Allan. Ttenbergen 15:42, 2019 June 25 (CDT)    		 2019-10-03 3:15:04 PM
    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) 2019-05-10 12:56:50 AM
    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. 2019-09-22 5:02:01 PM
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