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| == Additional Info == | | == Additional Info == |
| | This is the code for the "SARS-COV-2" virus. |
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| {{ICD10 Guideline COVID linker}} | | {{ICD10 Guideline COVID linker}} |
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| *Follow the same rules as usual for [[Primary Admit Diagnosis]]; that way our long term reporting doesn't get any weird discontinuities and if we need to report something for COVID we can still find that it was associated with the same priority:
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| ** it's only the primary if it meets the criteria in [[Primary Admit Diagnosis]], e.g. if they also have a stroke or trauma COVID might not be related to primary at all
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| ** code the infection as primary, not the pathogen
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| *This is a code for a viral pathogen officially called "SARS-COV-2". It causes a disease called "COVID-19", that has multiple infectious manifestations, with more likely to be identified over time.
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| **The main manifestation known as of January 2021 is a viral pneumonia which can evolve into [[ARDS (noncardiogenic pulmonary edema)]]. To code this viral pneumonia, use [[Pneumonia, viral]] with the bug being [[COVID-19 (SARS-COV-2)]].
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| **If as may be the case, there is a viral encephalopathy due to this bug, then you'd code it as [[Encephalitis, meningoencephalitis, myelitis, encephalomyelitis, viral]] with the bug being the same.
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| **If you have an asymptomatic patient who has tested positive, you can link this with [[Carrier of infectious disease, unspecified]].
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| **If you have a covid positive patient with GI symptoms only, you can combine with [[Gastrointestinal infection (gastroenteritis, colitis), viral]]
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| *Once active infection is gone (even if manifestations such as respiratory fibrosis and respiratory failure remain and continue to be coded) we will NOT use this code. Specifically, we do not have a coded for past history of COVID-19.
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| **Thus, this code should not be used as a comorbid diagnosis.
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| **Also, do not use this to code non-infectious complications or sequelae of COVID-19 -- see '''[[Post COVID-19 condition]]'''
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| * The majority of COVID Pos patients have myalgias, fatigue, or malaise. We do not collect this as per [[Template:ICD10 Guideline Signs Symptoms Test Results not needed when cause known]]
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| === Coding of pneumonia in the context of COVID ===
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| * As of May 2021, it has become clear that many or most COVID pneumonia patients are also being treated with broad spectrum antibiotics. This is despite evidence that few of these patients actually have superimposed bacterial pneumonia. There are ongoing attempts in Manitoba to get physicians to cease doing this, but it continues to occur. THUS, in someone with proven COVID pneumonia, even if the patient has been placed on antibiotics for possible bacterial pneumonia, you should NOT code bacterial pneumonia UNLESS there is clinical evidence it is present.
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| **This is different than usual coding of bacterial pneumonia, where a consistent clinical picture + use of antibiotics is sufficient to code it.
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| **The kinds of "evidence" you should use comes from airway/sputum cultures --- e.g. is a trach culture has lots of WBCs and grows a single organism, this is reasonable evidence (if the team is providing antibiotics). If on the other hand, the trach culture has few or moderate WBCs and grows "mixed oral flora", then this is evidence against superimposed bacterial pneumonia.
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| **This gets even murkier since many patients have long-term lung infiltrates after COVID pneumonia, which is usually NOT infectious but USUALLY represents pneumonitis and/or fibrosis, but ''CAN'' represent superimposed secondary infection.
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| **Bottom line on all this is you need to use your judgement, but do NOT code a bacterial pneumonia just because the docs are writing "post-COVID" pneumonia. See below for more info about that.
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| == Data Collection Instructions ==
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| === Will be used for MCHP (Manitoba Center for Health Policy) ===
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| Data about COVID is sent to MCHP so please adhere to the guidelines below closely so our data is well understood.
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| === Coding Suspected infection ===
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| If patient is a '''COVID suspect'''- combine [[COVID-19 (SARS-COV-2)]] with [[Observation for suspected infection NOS]] linked with the same number (don’t link it with any other infection code if not confirmed) Leave the code in, even if they later come up as a negative.
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| This should be coded on admission (if applicable) but subsequent swabs sent during the admission should not be coded as acquired diagnosis, unless the Swab is positive, then follow the usual guidelines for coding an acquired infection.
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| === Coding symptomatic infection ===
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| '''COVID positive''' patients- combine [[COVID-19 (SARS-COV-2)]] with other appropriate diagnosis such as [[Pneumonia, viral]], [[ARDS (noncardiogenic pulmonary edema)]]
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| === Coding asymptomatic infection ===
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| Combine [[COVID-19 (SARS-COV-2)]] with [[Carrier of infectious disease, unspecified]] <!-- as discussed at Task meeting November 18, 2020 -->
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| === Coding hospital acquired COVID ===
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| Add [[Nosocomial_infection,_NOS]] to what you would already code for this infection (ie might be different if symptomatic or not, or suspected etc, use the rules described elsewhere for that part).
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| === Isolation ===
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| Enter CCI [[Isolation, infectious]] if it is happening
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| === Infection status ===
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| *As we do with all infections, we do the best possible to identify the bug. Sometimes we're left without a clear, laboratory identification of the bug and then we use one or another of the "wastebasket codes"
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| **For example if the team believes this is likely a virus but doesn't know which one then use [[Virus, NOS]]
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| **For example if the team doesn't know what kind of bug it is, but believes it is infectious then use [[Infectious organism, unknown]]
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| ==== Presumed infections ====
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| If the team believes that this is COVID-19 (even without clear cut lab confirmation), then use [[COVID-19 (SARS-COV-2)]] as the organism - of course anybody seeking to do definitive analysis of all COVID-19 cases will need to obtain and use the data on confirmed cases from [[Cadham]].
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| ==== Confirmed infections ====
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| Done by [[Cadham]] Lab
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| ==== Delayed lab results ====
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| *Regarding people who either die or are discharged from hospital with their COVID-19 lab test still pending, follow the usual rules i.e: [[Lab_and_culture_reports#How_long_to_wait_for_a_result]] or [[Attribution of infections]]
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| **Note that this test is done by [[Cadham]] Lab and not by the usual DSM lab.
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| ==== When info about COVID status is found out long after locations are entered ====
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| No special rules for COVID, just use the normal [[Admit Diagnosis]] & [[Acquired Diagnosis]] rules.
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| === Post-COVID ===
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| * If appropriate, code [[Post COVID-19 condition]]
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| **See [[Post COVID-19 condition]] for how to handle the fact that some physicians are (confusingly) writing things like "post-COVID pneumonia" or "post-COVID pneumonitis" to indicate ongoing, noninfectious pulmonary sequelae after the ''active'' COVID infection itself is gone.
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| * If after COVID-19 has run its course there are no sequelae, then like any other acute issue that has disappeared, then don't code anything else.
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| === Other info ===
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| * [https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)]
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| * [https://en.wikipedia.org/wiki/Coronavirus_disease_2019 Coronavirus disease 2019 (COVID-19)]
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| == Alternate ICD10s to consider coding instead or in addition == | | == Alternate ICD10s to consider coding instead or in addition == |