Abstract: TH-PO890
Advocating for a Unique ICD-10 Code for ESRD Tunneled Catheter Bacteremia
Session Information
- Dialysis: Infection
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 610 Dialysis: Infection
Authors
- Avelar, Taurino N., Harbor-UCLA Medical Center, Torrance, California, United States
- Corado calvo, Katya, Harbor-UCLA Medical Center, Torrance, California, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
Background
In ESRD, infections account for 8% of cause-specific mortality. Hospitalizations are frequent, prolonged, and impair quality of life. Inpatient cost is ~$2.7 billion/yr. ICD-10 coding is intended to specifically characterize hospitalization clinical events. We tested whether ICD-10 coding accurately captures and distinguishes bloodstream infections (BSI) in ESRD patients with tunneled HD catheters from BSI in patients with other implanted devices.
Methods
This is a single-center retrospective chart review in patients with BSI from 10/1/15–12/31/16. Subjects were grouped: (Gp1) ESRD BSI from tunneled dialysis catheter infection; (Gp2) ESRD BSI with AV fistula (AVF) or graft (AVG); and (Gp3) Non-ESRD BSI from an implanted device (PICC lines, ICD/pacer leads, bioprosthetic/mechanical heart valves, orthopedic hardware, and non-HD grafts/stents (vascular, ureteral). Groupings were based on: (Gp1) Infectious Diseases Society of America Guidelines for Intravascular Catheter-Related Infection (CID 2009:49); (Gp2) Positive blood cultures in ESRD with AVF or AVG; and (Gp3) Positive blood/wound cultures, physical exam, radiological assessments, and biopsy results. We descriptively compared the use of ICD-10 codes among the clinical groups.
Results
Table shows ICD-10 codes used to classify the BSI events in these 3 groups. For some, >1 ICD-10 code was used. In 12, no code was used. There is substantial overlap in the ICD-10 codes used to describe BSI in patients with ESRD tunneled catheters, AVFs, and AVGs, and non-ESRD BSIs associated with other implantable devices.
Conclusion
In this "Discovery" cohort, the lack of a unique ICD-10 identifier for BSI due to tunneled dialysis catheters makes it difficult or impossible to distinguish these clinical events from other BSIs. "Validation" cohorts at other centers is in progress. A unique code is needed to quantify the burden of this devastating clinical entity.
ICD-10 codes in patients with BSIs
| ICD-10 diagnosis | ICD-10 code | Gp1, n=19 | Gp2, n=7 | Gp3, n=17 |
| BSI due to central venous catheter | T80.211A | 0 | 0 | 1 |
| Bacteremia/Sepsis | A41.01, A41.02, A41.89, A41.9, R65.20, R65.21, R78.81 | 18 | 5 | 5 |
| Infection, inflammation, or other reaction/complication of vascular or cardiac valvular devices, implants, grafts | T82.898S, T82.6XXS | 0 | 0 | 2 |
| Infection, inflammation, from other complication of vascular or cardiac valvular devices, implants, grafts | T82.7XXA, T82.7XXS | 0 | 0 | 0 |
| Acute or subacute endocarditis | I33.9, I38 | 2 | 0 | 1 |
| Abscess, discitis | K65.1, L02.91, M46.46 | 2 | 1 | 0 |
| Cellulitis, UTI, pyelonephritis, aneurysm, unspecified | L03.90, N39.0, N12, R89.9, I71.2 | 2 | 1 | 2 |
| No code for infection | - | 4 | 1 | 7 |