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Transfusion Reaction

Transfusion Reaction. September 2008 Coding and Maintenance Committee Meeting Presented by Patrick S. Romano, MD, MPH on behalf of the Agency for Healthcare Research and Quality. Background.

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Transfusion Reaction

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  1. Transfusion Reaction September 2008 Coding and Maintenance Committee Meeting Presented by Patrick S. Romano, MD, MPH on behalf of the Agency for Healthcare Research and Quality

  2. Background • Transfusion reactions occur when antibodies in the patient’s blood react to components in the transfused blood • Can be life threatening or minor • Types of transfusion reaction • Major types: ABO and Rh • Minor types: e.g. Kell, Duffy, Kidd, Lewis, E • Minor antigens may cause serious or mild reactions, but are uncommon in the general population (major risk factor is prior transfusion therapy)

  3. Preventing transfusion reaction • Major antibodies (ABO/Rh) routinely screened through type and cross in non-emergent cases • Minor antibodies are not screened, unless patient has a history of transfusion reaction to one of these minor antibodies • Failure to screen or faulty screening for major antibodies before non-emergent transfusions is a serious medical error (usually occurs at POC) • National Quality Forum Serious Reportable Event • AHRQ Patient Safety Indicator • CMS Hospital Acquired Condition

  4. Current Coding Structure • 999.6 ABO incompatibility reaction • Index instructs coders to code minor specified blood group antigens (Duffy, E, Kell, Kidd, Lewis, M, N, P, S) to 999.6 • This code combines preventable ABO reactions with those generally considered nonpreventable in most patients • Record review study (7 cases) by National Association of Children’s Hospitals and Related Institutions (NACHRI) in 2008: 2 POA, 4 clearly nonpreventable, 1 uncertain

  5. Proposed coding structure • 999.6 ABO incompatibility reaction • Exclude minor blood group antigens • Add new code • 999.87 “Other specified transfusion reaction” • Revise 999.89 • Unspecified transfusion reaction • Permits tracking of ABO and minor incompatibility reactions separately • Limits 999.6 to preventable reactions

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