Questions for Kumar Team Meeting June 6, 2012

Questions for Kumar Jun 6 team meet- HSC site submitted

1. Examples of culture reports to be put up on projector: questions in regards to how to interpret

• Pat Stein provided four examples

Case examples & questions:

1. COPD’s

• pts thrown onto Antibiotics (IV and/or PO)
• no cultures sent majority of the time
  • Question: should this be coded as a CAP or bronchitis?

• RE: Septicemia - our DX code book says septicemia (bacteremia/fungemia)

1. a.)

• RE: Medicine ward patient
  • Pt admitted with fever NYD
  • Blood cultures negative
  • Doctor note – not mention of sepsis
    • Question: How do we code?

1. b.)

• RE: Medicine ward patient
  • Pt admitted with DX of being “Septic” as per Doc notes
  • Blood cultures negative
  • TX with IV then PO antibiotics
    • HSC codes as septicemia with subcode negative blood cultures.
      • Question: a.) Should this be coded as septicemia?
      • Question: b.) Is it better to overcode than undercode?

1. a.)

• Patient with pseudomonas in the ETT secretions
  • no infiltrate on CXR
  • no other signs of symptoms of pneumonia

1. b.)

• Patient has stenotrophomonas maltrophilia in ETT secretions
  • no infiltrate on CXR
    • Question: Which organisms could fall under the category of “resistant organisms WITHOUT infection”?

1. a.)

• Patient being treated for HAP and has ETT cultures that are +ve for stenotrophomonas maltophilia
  • recovers of first incident of HAP and is off antibiotics
  • Gets a “second incident” of HAP. ETT cultures are now +ve for ecoli and stenotrophomonas.
  • for this culture, ecoli is only tested for sensitivity
    • Question:a.) Is the second incident of HAP due to mixed bacteria or is it ecoli?
    • Question b.) what exactly does it mean when sensitivities on mixed cultures are specific to one organism?
    • Question c.) why are there no sensitivities done on some cultures and no sensitivities are done but antibiotics are given?
      • Example: ETT 2+ stenotrohomonas maltophilia & 2+ enterococcus (but no sensitivity done).

1. Question: Should cultures +ve with yeast be codes as infection if no treatment?

1. Shingles – HSC staff use the subcode varicella zoster even if no culture sent.

• When coding zoster infections of the skin (cellulitis) often the diagnosis is made without a specimen being sent. It is more important to get the right diagnosis than whether a culture was sent or not, therefore, put in cellulitis and the organism even if a sample was not sent. If herpetic skin infections are audited the auditor will know that the diagnosis is usually made by clinical observation only.
  • • Question: a.) Is the above method correct to capture?
    • Question: b.) Are there other infection we should do the same for? Example "thrush"?

1. Question: Is there a good reference article on types of types of infections in ICU that is current that would be a good resource for collectors?