Admissions with overt GI bleeding occurring on or within the first 24 hours of admission were excluded. If the 2 reviewers did not come to an agreement, the case was adjudicated by a third reviewer (E.R.M.). and B.P.V.), and any ambiguous cases were reviewed by the other. All medical charts were reviewed by 1 of 2 reviewers (S.J.H. We reviewed the medical records of all administratively identified cases to validate presence of overt bleeding, timing of the bleeding, and patient location at the time of the bleeding.
#Icd 10 code for gi bleed code
The secondary outcome was clinically significant nosocomial GI bleeding, defined as our primary outcome, with the additional requirement of either an ICD-9-CM procedure code for upper endoscopy or receipt of at least 2 units of packed red blood cells during the admission.
#Icd 10 code for gi bleed software
ICD-9-CM codes used for this administrative outcome definition were based on the Clinical Classifications Software (CCS)-a diagnosis and procedure categorization scheme maintained by the Agency for Healthcare Research and Quality (AHRQ) 22-with modification as noted in the eAppendix. To identify such cases, we reviewed the medical charts of all admissions identified as having a discharge International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) code for GI bleeding listed as a secondary discharge diagnosis. The primary outcome was nosocomial GI bleeding occurring outside of the ICU, defined as any overt GI bleeding (hematemesis, nasogastric aspirate containing “coffee grounds” material, melena, or hematochezia) occurring more than 24 hours after hospital admission, in a patient outside of the ICU. We sought to examine these issues, hypothesizing that while acid-suppressive medication use would be associated with a reduced incidence of nosocomial GI bleeding, the incidence of this complication would be low, causing the number needed to treat (NNT) to be high. To our knowledge, the incidence of nosocomial GI bleeding and the effect of acid-suppressive medication on this complication have not been well examined in a large cohort of noncritically ill patients. 20, 21 Both trials were small, lacked double blinding, did not evaluate proton pump inhibitors, and were restricted to patients with very severe illness and presumed risk factors for stress ulceration, limiting their generalizability to the average inpatient receiving acid-suppressive medication outside of the ICU. Two randomized controlled trials have evaluated the effect of acid-suppressive medications on GI bleeding outside of the ICU. 1 In this context, balancing the risks and benefits of acid-suppressive medication in hospitalized patients requires a better understanding of possible benefits of these medications, particularly potential reductions in the competing risk of nosocomial GI bleeding. In addition to the financial cost incurred by this practice, several recent studies have demonstrated increased risks of infection associated with use of acid-suppressive medication in hospitalized patients, including Clostridium difficile infection 17 - 19 and hospital-acquired pneumonia. 9 - 15 While current guidelines recommend against the routine use of prophylactic acid suppression in patients outside of the intensive care unit (ICU), 16 this recommendation is based on expert consensus there are little data available on the incidence of nosocomial GI bleeding in the non-ICU population and whether these patients would benefit from acid-suppressive medication. 4 - 8 This practice appears to have stemmed from the use of acid suppression to prevent stress-related gastrointestinal (GI) tract bleeding (GI bleeding) in critically ill patients, where the incidence of nosocomial GI bleeding and the effect of acid-suppressive medication have been well characterized. 1 - 3 Although some of these patients have clear indications for acid suppression, research has consistently found that most do not. Studies estimate that 40% to 70% of medical inpatients receive acid-suppressive medications during their hospitalization.
The use of acid-suppressive medication in hospitalized patients has increased significantly over the last several decades. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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