Reasoning around moving to ICD10 and our subset of it

This article explains our choice of ICD10 as a coding schema and of the subset of codes we include.

Why are we moving to a new diagnostic coding schema?

Our old diagnosis list was made in-house designed mostly for the Critical Care setting where our database started out. We are moving to a new diagnosis set primarily to make our data set more comparable to other data sets, and to include more diagnoses that are relevant to Internal Medicine physicians outside of the ICU setting.

Why are we moving to ICD10 rather than a different coding schema?

ICD10 is one of the most widely used diagnosis coding standards. It is the diagnosis coding schema used in all hospitals in Canada, including those in Manitoba. Using the same system as used elsewhere means that diagnoses don't need to be translated to another system, where often a 1-to-1 translation is not possible. It also means that our definitions are more likely to be equivalent to those used by other data sets.

Another benefit of moving to ICD10 will be that it should eliminate diagnoses for which we don't have a code, since ICD10 includes codes for diagnoses that have no specific code.

Why are we including the subset of diagnoses that we do

We are seeing increased interest by Internal Medicine physicians in our data set. Since they fund our program to a large extent, we need to make sure our data includes what they are interested in, in a format that is usable for them.

Why are we including some codes that are not part of ICD10-CA

Non-standard ICD10 Diagnoses lists these and provides reasons.

Why do we not include the entire set of ICD10 codes

The full ICD10 includes over 16000 diagnosis codes. We decided to only use a subset of this to make it easier to learn the new list. Any diagnoses whose codes we omitted can be assigned to the next more general NOS code.

Should we remove some?

Some diagnoses such as Alopecia (nonscarring hair loss), Albinism (albino), disorder of the nails do not initially seem significant enough to code. However, they should be retained so that they can be used as comorbidities, especially for medicine patients. For example, albinism is a condition associated with other genetic abnormalities.

Concerns

Pathogen issues

do we eliminate some of the subspecies and in ICD10 only put them under species only?

• SMW

• Cargo

• Categories

• Klebsiella: only have Klebsiella supp in IDC10, not K. Oxytoca, K. pneumoniae. Agreed to group under sub spp.
• Serratia: no sub categories - old codes migrated to just Serratia
• Candida: no sub categories
• Enterococcus: no sub categories
• Corynebacterium species: not in list.

• We need to be quite specific in our database in order to properly code VAP criteria, CLI etc. I don’t think the pathogen list for bacteria is extensive enough. No mixed option so would need to put in each pathogen separately. Is Dr Kumar OK with this list?

set a limit to pathogen list

• SMW

• Cargo

• Categories

From: Rob Ariano - Subject: RE: VAP organisms 
Sent: Thursday, February 15, 2018 8:32 AM
To: Laura Kolesar, Cc: Trish Ostryzniuk

Hi Laura, Yes, Dr. Allan Garland had asked me about that; but I hadn’t noticed all the missing ones that you have identified below.      I just mentioned that I felt that S.maltophilia should be tracked. 
Looking at your listing below I would now suggest that we also add:
*All Klebsiella
*All Serratia
*All Citrobacter
*All Enterobacter
*All Acinetobacter
Those are all important Gram-negative rods causing serious pneumonia as seen in the critical care / infectious diseases literature. ESBL’s are an especially important problem with all Klebsiella species, and Amp-C beta-lactamases have been found commonly with the remaining ones listed above.  
I would not list Candida, nor Enterococcus.
Can you let Allan know that I had not noticed these missing? Thanks,Rob

• Allan agreed we should add these however, we must be careful as the list of pathogen is endless! I do not think we should collect all sub species related to a specific pathogen. For example, we collected Klebsiella oxytoca and pnuemoniae before and any other species was just put under Klebsiella SPP. We will take this to Steering meeting. 18:56, 2018 February 22 (CST)

Diagnosis issues

coding Medication/therapy non-compliance

• SMW

• Cargo

• Categories

• Medication/therapy non-compliance...I see the need for some reflection of this issue in a diagnostic code as I have frequent admission/ re-admissions for non-compliance with medications and/or therapies especially dialysis.--Llemoine 14:31, 2018 February 22 (CST)

Diagnosis codes missing in ICD10

• SMW

• Cargo

• Categories

• Septic Emboli: no specific code even though it is a very significant problems with endocarditis patients which can cause widespread clotting to any blood vessels which causes strokes, ischemia to many organs, etc.

• Vasculitis: only options are limited to skin, NOS or necrotizing vasculopthy/vasculitis NOS

• Intra-abdominal abscess: only options are intestine, anus, liver, peritonitis. No pancreatic abscess (do have pancreatitis and pseudocyst).

• Cardiac arrest - Does not differentiate between witnessed or unwitnessed arrest.

• Need for medical isolation - Isolation is on the Patient is on isolation (TISS Item) and in Isolation-Task, do we need to include this in the diagnosis list?
  • definition in Tasks is different, and we are thinking about discontinuing it. Ttenbergen 21:57, 2018 March 20 (CDT)

APACHE/Charlson in ICD10

• We currently put in a level of severity in our comorbids. Ie COPD- mild, mod or severe. Is it OK to not have this information? Without the severe designation we may miss the chronic history component of apache (severe liver, lung, etc.)
  • according to Allan, the ICD10 Codes can be translated to give you Charlson and Apache. Do you have specific concerns? See the following:
    • Charlson Comorbidities in ICD10 codes
    • APACHE Comorbidities in ICD10 codes
    • APACHE Acute Dxs in ICD10 codes

Completeness / Do we need to add codes?

• Are all previous conditions being put in this list? If so, this is a significant increase in numbers of codes required.
  • What do you mean by that? Ttenbergen 23:08, 2018 March 20 (CDT)

• Previous conditions refers to comorbids. We need to know if all previous conditions that a patient has had in their lifetime (their history) must be documented in the comorbids. Many conditions are old and irrelevant to the current admission. What is our guideline here as our comorbid list is much broader now than our original comorbid list. Please clarify.

• Do we need methamphetamine added?
• ( I recently had this on one of my patients and I ended up using psychoactive substance NOS, chronic abuse/dependence/addiction. When I googled meth, it came up as a psychoactive drug.)--LKolesar 11:52, 2018 February 13 (CST)