Drug-induced immunosuppression

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CCI Picklist
Procedure: Drug-induced immunosuppression
CCI Picklist code: T99
CCI Collection Mode: CCI collect first
Start Date: 2021-04-19
Stop Date: 2022-04-06

This procedure is a part of CCI Collection via CCI Picklist.

Special collection mode

This code is categorized as "collect first", but the instructions are really a bit more specific. This code should be used for patients who already have drug-induced immunosuppression before they get to your service. The code is part of a replacement of Chronic Health APACHE where we will derive this value from ICD10 codes instead, so should be coded following the same principles.

So, it should always be coded as Px Type "Admit".

The code is still categorized as collect first since the special rules for this code are a subset of that mode to this and should be compatible with cross checks.

Additional Info

Code when patient is on one of the following:

List of immunosuppressive drugs   
  • Used to treat an increasing variety of conditions: immune-mediated (RA, UC, Crohn's, lupus, MS, psoriasis, etc); after organ transplant.
  • Only considered immunosuppressive if given systemically (po, im or iv)
  • Corticosteroids (unlike all the others, these only count if > a given daily dose and used for at least 2 weeks prior to admission)
    • Dexamethasone: >0.25 mg/day
    • Hydrocortisone: >40 mg/day
    • Prednisone (methyl-prednisolone): >10 mg/day
    • Prednisolone: >8 mg/day
  • Cancer chemotherapy -- includes any agents, if received within the past 6 months
  • Nonsteroidal immunosuppressives -- includes any of these, if received within the past 1 month
    • Abatacept (Orencia)
    • Azathioprine (Imuran)
    • Adalimumab (Humira)
    • Anakinra (Kineret)
    • Basiliximab (Simulect)
    • Certolizumab (Cimzia)
    • Cyclophosphamide (Cytoxan)
    • Cyclosporine
    • Daclizumab (Zinbryta)
    • Etanercept (Enbrel)
    • Everolimus (Afinitor, Zortress)
    • Golimumag (Simponi)
    • Infliximab (Remicade)
    • Ixekizumab (Taltz)
    • Leflunomide (Arava)
    • Lenalidomide
    • Methotrexate
    • Mycophenolate (CellCept)
    • Natalizumab (Tysabri)
    • Rituximab (Rituxan)
    • Secukinumab (Cosentyx)
    • Sirolimus (Rapasumne)
    • Tacrolimus (Prograf)
    • Tocilizumab (Actemra)
    • Tofacitinib (Xeljanz)
    • Ustekinumab (Stelara)
    • Vedolizumab (Entyvio)

Do not include

  • hydroxychloroquine - as per task meeting 2022-04-20 it is an immune modulator, but not very immunosuppressive

Alternate ICD10s to consider coding instead or in addition

Data Integrity Checks (automatic list)

none found

Log

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