List of ALARMING Diagnoses

Transcription

1 List of ALARMING Diagnoses Diagnosis Code Diagnosis Diagnosis Type Eligible for Incentive/Tier 584 (!) ANTHRAX C requires a clinically compatible illness plus laboratory confirmation via culture, nucleic acid testing, antigen testing (immunohistochemistry), seroconversion (4- fold rise) or other confirmed method of identification of the organism. Use P for a clinically compatible illness epidemiologically linked to a confirmed exposure to B. anthracis but without corroborative laboratory evidence. 591 (!) BOTULISM Compatible clinical picture with or without the presence of an epidemiologic link to other confirmed or suspected botulism cases. C requires compatible lab data including isolation of C. botulinum from stool, wound, or food and/or isolation of toxin from serum, wound, or food. P is assigned if clinically suspected and all other possible etiologies have been appropriately ruled out but lab confirmation is absent. 675 (!) (*) CHAGAS' DISEASE, ACUTE positive microscopy, nucleic acid test, xenodiagnosis, or two positive serological tests using different antigens. P is not allowed. Specify acquisition method: Vector, Transfusion, Transplantation, Congenital, Other. 535 (!) (*) CHOLERA (TOXIGENIC V. CHOLERA O1/O139) C requires positive culture or nucleic acid test. P allowed for compatible serious clinical disease in an outbreak setting. Specify as much information about serotype and strain of the V. cholera bacteria as possible. Gastrointestinal: 551 (!) CRIMEAN-CONGO HEMORRHAGIC FEVER (CCHF) or positive serology with either a positive IgM or IgG, or a 4-fold rise in IgG. Cannot use P. 601 (!) (*) DEATH Specify cause or presumed cause of death by adding additional diagnosis code(s) if appropriate. Specify cause or presumed cause of death: Syndromic Death 127 (!) DENGUE, COMPLICATED C requires compatible clinical illness with appropriate epidemiology and 1) evidence of clinically significant plasma leakage OR 2) clinically significant hemorrhage/bleeding. Can also use if there is confirmed dengue infection with organ failure or shock. Use P if there is a single positive IgM result or a high positive IgG result and clinical illness meeting criteria for complicated disease. 808 (!) DIPHTHERIA: PHARYNGEAL OR TRACHEOBRONCHIAL Use C in the setting of relevant clinical manifestations including an adherent pseudomembranetogether with positive culture of C. diphtheriae and a positive toxin assay, nucleic acid testing or seroconversion/4-fold rise in serology. Cannot use P. 791 (!) (*) E. COLI, SHIGA TOXIN PRODUCING (aka Enterohemorrhagic E. COLI, EHEC/Verocytotoxin-producing E. coli, VTEC); includes E. coli 0157:H7 C requires positive specialized culture or positive nucleic acid test. Cannot use P. Add ( ) Gastrointestinal: 1/6

2 #792 HEMOLYTIC UREMIC SYNDROME (SHIGA TOXIN ASSOCIATED) to the record for cases where this complication occurs. State O and H antigen serotype if known. State if Shiga toxin or Shiga toxin genes demonstrated 567 (!) EBOLA VIRUS Compatible clinical illness with history of exposure in endemic areas of Africa or with contact with another known case. Diagnosis requires viral isolation, nucleic acid testing, or positive serology. 138 (!) (*) ENCEPHALITIS, ACUTE SPECIFIC ETIOLOGY Fever, headache, and altered mental status ranging from confusion to coma with or without additional signs of brain dysfunction usually with CSF pleocytosis. Cannot use P. Use this code only if there is an identifiable agent by histology, culture, nucleic acid testing, antigen or serological testing. Use the diagnosis code for specific etiologic agent if available, otherwise, use this code and specify etiologic agent. Specify etiology 616 (!) ENCEPHALITIS, VENEZUELAN EQUINE C requires compatible clinical and epidemiological history and lumbar puncture findings showing elevated white blood cells plus either identification of VEEV by isolation of virus or nucleic acid testing on blood or CSF, or positive serology (IgM) from CSF. Can also use C if there is a seroconversion with a 4-fold rise in neutralizing antibody titers in serum. Use P if lumbar puncture findings show elevated white blood cells and either a single serum IgG or CSF IgG positive for VEEV 613 (!) HANTAVIRUS either virus isolation, positive nucleic acid testing, histopathology or positive serology. Use for any hantavirus group illness including Hantaan, Dobrova, Seoul, Puumala, Sin Nombre, Andes, Laguna Negro virus and others. 792 (!) HEMOLYTIC UREMIC SYNDROME (SHIGA TOXIN ASSOCIATED) Compatible clinical illness, usually with antecedent infection with a Shiga toxin producing organism. Use this code together with #791 E. COLI, SHIGA TOXIN PRODUCING when appropriate. Genitourinary and STDs: 568 (!) (*) HEMORRHAGIC FEVER SYNDROME, ACUTE Compatible clinical syndrome without a specific viral diagnosis. Specify etiologic agent if known. Specify etiology 736 (!) INFLUENZA, AVIAN C requires positive rapid test, PCR, or culture. Cannot use P. If pt has abnormal CXR and proven influenza, both pneumonia and influenza codes should be used. 565 (!) LASSA FEVER or positive serology. 156 (!) (*) MALARIA, ARTEMISININ-RESISTANT OR artesinin and 2) documentation of therapeutic drug levels. Use P for malaria confirmed by microscopy with clinical treatment failure, without complete lab confirmation as above. Must also include a specific species code (175 2/6

3 P. falciparum, 176 P. malariae, 177 P. ovale, 178 P. vivax, or 769 P. knowlesi). Specify whether therapeutic failure and specific genetic mutation if known. 697 (!) (*) MALARIA, ATOVAQUONE/PROGUANIL- RESISTANCE OR atovaquone and/or proguanil and 2) documentation of therapeutic drug levels. Use P for malaria confirmed by microscopy with clinical treatment failure, without complete lab confirmation as above. Must also include a specific species code (175 P. falciparum, 176 P. malariae, 177 P. ovale, 178 P. vivax, or 769 P. knowlesi). Specify whether therapeutic failure, prophylaxis failure, and specific genetic mutation if known. 735 (!) (*) MALARIA, MEFLOQUINE- RESISTANT OR mefloquine and 2) documentation of therapeutic drug levels. Use P for malaria confirmed by microscopy with clinical treatment failure, without complete lab confirmation as above. Must also include a specific species code (175 P. falciparum, 176 P. malariae, 177 P. ovale, 178 P. vivax, or 769 P. knowlesi). Specify whether therapeutic failure, prophylaxis failure, and specific genetic mutation if known. 620 (!) (*) MALARIA, PRIMAQUINE-RESISTANT OR primaquine and 2) documentation of therapeutic drug levels. Use P for malaria confirmed by microscopy with clinical treatment failure, without complete lab confirmation as above. Must also include a specific species code (175 P. falciparum, 176 P. malariae, 177 P. ovale, 178 P. vivax, or 769 P. knowlesi). Specify whether therapeutic failure, prophylaxis failure, and specific genetic mutation if known. 563 (!) (*) MALARIA, QUININE-RESISTANT OR quinine and 2) documentation of therapeutic drug levels. Use P for malaria confirmed by microscopy with clinical treatment failure, without complete lab confirmation as above. Must also include a specific species code (175 P. falciparum, 176 P. malariae, 177 P. ovale, 178 P. vivax, or 769 P. knowlesi). Specify whether therapeutic failure and specific genetic mutation if known. 555 (!) MARBURG VIRUS or positive serology with either a positive IgM or IgG, or a 4-fold rise in IgG. Cannot use P. 847 (!) MAYARO VIRUS C requires compatible clinical history with compatible exposure history in endemic areas of Central or South America or the Caribbean, and either virus isolation, positive nucleic acid test, or seroconversion/rising titre on serology. Use P if there is a compatible clinical and exposure history with a single positive serology result. Compatible clinical illness after exposure 3/6

4 without laboratory testing should be coded as 219 VIRAL SYNDROME (WITH OR WITHOUT RASH). 831 (!) MENINGITIS, LISTERIA C requires a compatible clinical presentation along with isolation of L. monocytogenes from the CSF via microscopy, culture or nucliec acid test. May also use C for CSF results compatible with bacterial meningitis and L. monocytogenes isolated from blood (also add code #108 BACTEREMIA). Cannot use P. Use code #460 MENINGITIS, BACTERIAL, UNSPECIFIED if no organism is identified. 461 (!) MENINGITIS, MENINGOCOCCAL C requires a compatible clinical presentation along with isolation of N. meningitidis from the CSF via microscopy, culture, antigen testing or positive nucleic acid testing. May use C for CSF results compatible with bacterial meningitis and meningococcus isolated from blood (also add code #108 BACTEREMIA). May use P in the face of an outbreak of known meningococcal meningitis with a compatible clinical syndrome and an epidemiological link. If applicable, use code #830 MENINGITIS, OTHER SPECIFIED BACTERIAL AGENT or #460 MENINGITIS, BACTERIAL, UNSPECIFIED. 806 (!) MERS Co-V Use C for a patient, with or without a compatible clinical illness, with positive nucleic acid testing for MERS-CoV. Use P for a compatible clinical illness with absent, negative, or inconclusive laboratory testing for MERS-CoV who is also either 1) epidemiology linked to a laboratory confirmed MERS-CoV case or 2) resides in or traveled to an area with known MERS-CoV circulation. 813 (!) MYCOBACTERIUM TUBERCULOSIS, pre-xdr C requires laboratory evidence. Use P when only clinical evidence of non-response to firstline drugs (isoniazid and rifampicin) is available PLUS resistance to either one of the fluoroquinolones (such as ofloxacin or moxifloxacin) OR to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin). Use this code in addition to 136, 209, 211, 223, 625, 626, or 676 which denote the clinical presentation of disease. 814 (!) MYCOBACTERIUM TUBERCULOSIS, XDR C requires laboratory evidence. Use P when only clinical evidence of non-response to firstline drugs (isoniazid and rifampicin) is available PLUS resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) AND to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin). Use this code in addition to 136, 209, 211, 223, 625, 626, or 676 which denote the clinical presentation of disease. 561 (!) NIPAH VIRUS C requires compatible clinical and epidemiological history and either: i) Nipah virus isolation by antigen, culture or nucleic acid testing from serum, CSF, or other body fluid, OR ii) Nipah virus detection on histopathology OR iii) a 4-fold rise in Nipahspecific serum serology using a neutralization test. Use P for a single serology result (IgM or IgG) detected by ELISA. 848 (!) OROPOUCHE VIRUS C requires compatible clinical history with compatible exposure history in endemic areas of Central or South America or the Caribbean, and either virus isolation, positive nucleic acid 4/6

5 test, or seroconversion/rising titre on serology. Use P if there is a compatible clinical and exposure history with a single positive serology result. Compatible clinical illness after exposure without laboratory testing should be coded as 219 VIRAL SYNDROME (WITH OR WITHOUT RASH). 644 (!) POISONING, SHELLFISH Compatible epidemiological and clinical history of a primarily gastrointestinal and/or neurologic symptoms after ingestion of bivalve mollusks (such as mussels, clams, oysters, scallops). Types of shellfish poisoning include diarrhetic (DSP) paralytic (PSP), neurotoxic (NSP) and amnesic (ASP). Cannot use P. 788 (!) POLIOMYELITIS either virus isolation or positive nucleic acid test. 189 (!) Q FEVER (COXIELLA BURNETII) C requires compatible clinical history and diagnosis via serology (seroconversion or rising antibody titre), culture, nucleic acid testing or histopathology. Use P for single serology positive for phase II antigen, with a negative or lower phase I antigen. 349 (!) RABIES C requires compatible clinical syndrome with i) positive virus isolation, nucleic acid testing or serology on serum, spinal fluid or other specimen, or ii) positive skin biopsy for rabies antigen. C may be used with post-mortem proof by immunohistology or isolation of virus from CNS material. Cannot use P. 643 (!) RIFT VALLEY FEVER or positive serology. 820 (!) SARCOCYSTOSIS, MUSCULAR Compatible clinical illness consisting of otherwise unexplained and prominent myalgia and eosinophilia, with or without a history of fever. C requires Sarcocystis-like muscle cysts identified on histopathologic examination of muscle biopsy AND/OR a positive Sarcocystis spp. PCR analysis of muscle biopsy specimen. P requires myositis by clinical judgment on physical examination OR prominent myalgia with elevated serum CPK (>200 U/L) OR myalgia and findings of inflammation consistent with myositis on histopathologic examination of muscle biopsy AND eosinophilia (absolute eosinophil count >500/mm3) AND negative serologic testing for trichinosis. Other: infectious and/or 845 (!) (*) SERIOUS ADVERSE EVENT (SAE), DRUG- RELATED (INCLUDING ANTI-MALARIALS) Compatible clinical history and/or clinical diagnosis of SAE: defined as death or lifethreatening reaction (e.g. anaphylaxis), or reaction that leads to inpatient hospitalization or prolongation of existing hospitalization associated with the use of a travel- drug. NOTE: If this event occurred BEFORE TRAVEL TOOK PLACE, no travel history information needs to be entered and please i) use Seen During Travel for Clinical Setting, ii) in addition to checking the symptoms of the reaction Under Main Presenting Symptoms and Reason for Referral, type Pre-travel reaction in the Other field, iii) Diagnosis Method most likely will be Clinical. Specify name of drug and reaction. Enter Not Ascertainable if multiple drugs and/or causative agent are indeterminable. Adverse Events to Medication or Vaccine 844 (!) (*) SERIOUS ADVERSE EVENT (SAE), VACCINE- Adverse Events 5/6

6 RELATED (INCLUDING YF) Compatible clinical history and/or clinical diagnosis of SAE: defined as death or lifethreatening reaction (e.g. anaphylaxis), or reaction that leads to inpatient hospitalization or prolongation of existing hospitalization associated with the use of a travel- vaccine. NOTE: If this event occurred BEFORE TRAVEL TOOK PLACE, no travel history information needs to be entered and please i) use Seen During Travel for Clinical Setting, ii) in addition to checking the symptoms of the reaction Under Main Presenting Symptoms and Reason for Referral, type Pre-travel reaction in the Other field, iii) Diagnosis Method most likely will be Clinical. Specify name of vaccine and reaction. Enter Not Ascertainable if multiple vaccines and/or causative agent are indeterminable. to Medication or Vaccine 729 (!) SEVERE ACUTE RESPIRATORY SYNDROME (SARS) Compatible clinical picture with confirmatory viral isolation or nucleic acid testing. 695 (!) SMALLPOX (VARIOLA MAJOR) C requires compatible clinical syndrome in the context of a possible laboratory exposure or bioterrorism-suspected event, along with biopsy of skin lesions with specialized laboratory assistance to differentiate from other orthopox viruses. 671 (!) TRYPANOSOMIASIS, AFRICAN (T. B. GAMBIENSE) C requires compatible clinical illness, exposure history and positive microscopy, nucleic acid test, or serology. Can use P if unable to differentiate from code 363 TRYPANOSOMIASIS, AFRICAN (T. B. RHODESIENSE). 363 (!) TRYPANOSOMIASIS, AFRICAN (T. B. RHODESIENSE) C requires compatible clinical illness, exposure history and positive microscopy or nucleic acid test. Can use P if unable to differentiate from code 671 TRYPANOSOMIASIS, AFRICAN (T.B. GAMBIENSE) on the basis of epidemiology or testing. 696 (!) TULAREMIA positive microscopy, culture, histopathology, or nucleic acid test, or seroconversion/rising titre on serology. Use P if there is a single positive serology result. 566 (!) YELLOW FEVER C requires compatible clinical illness with history of being in endemic region and viral isolation or serology using blood/csf. 564 (!) YERSINIA PESTIS (BUBONIC or PNEUMONIC) positive microscopy, culture, histopathology, nucleic acid test or Ag detection, or seroconversion/rising titre on serology. Use P if there is a single positive serology result. (!) = Alarming Diagnosis (*) = Additional Information Requested ( ) = Requires Diagnosis Method ( ) = Allows Antibiotic Resistance 1/17/2019 2:22:53 PM 6/6