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 diagnosisICD-10 codeGp1, n=19Gp2, n=7Gp3, n=17
BSI due to central venous catheterT80.211A001
Bacteremia/SepsisA41.01, A41.02, A41.89, A41.9, R65.20, R65.21, R78.811855
Infection, inflammation, or other reaction/complication of vascular or cardiac valvular devices, implants, graftsT82.898S, T82.6XXS002
Infection, inflammation, from other complication of vascular or cardiac valvular devices, implants, graftsT82.7XXA, T82.7XXS000
Acute or subacute endocarditisI33.9, I38201
Abscess, discitisK65.1, L02.91, M46.46210
Cellulitis, UTI, pyelonephritis, aneurysm, unspecifiedL03.90, N39.0, N12, R89.9, I71.2212
No code for infection-417