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

Powerpoint Presentation

Slide 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

Slide 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)

Slide 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

Slide 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

Slide 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

Classification Sources

Data Resources

National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782
Phone:
1-800-232-4636
cdcinfo@cdc.gov

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A
Tel: (404) 639-3311 / Public Inquiries: (404) 639-3534 / (800) 311-3435