1226. Differences in diagnosis and procedure codes used among 5 Veterans Affairs telehealth antibiotic stewardship services

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Abdelrahim, Sara A, Wilson, Brigid, Vivo, Amanda, Walkner, Tammy, Ewers, Tola M, Livorsi, Daniel J, Crnich, Christopher J, Sabzwari, Rabeeya, Webster, Andrew S, Epstein, Lauren H, Milner, Amelia, Jump, Robin L, Evans, Charlesnika T, Bej, Taissa A
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.1066

Abstract Background Telehealth offers an opportunity for rural healthcare settings to connect with infectious disease (ID) experts to augment clinical care of people with suspected infections and to support antimicrobial stewardship efforts. We are currently disseminating a project that uses Veterans Affairs (VA) telehealth systems to connect multidisciplinary teams from rural VA medical centers with ID experts at geographically distant locations to form Videoconference Antimicrobial Stewardship Teams (VASTs). Here, we used diagnosis and procedure codes to describe preliminary outcomes from 5 VASTs, assessing the time used for each consult as well as the infectious and other clinical syndromes discussed. Methods We extracted Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) codes associated with clinical encounters from January 2022 – April 2023 for 5 VASTs. CPT codes indicated the time spent by the ID expert. ICD-10 codes were summarized into the following broad categories: infections, pathogens, other clinical diagnoses, signs and symptoms, treatments, and administrative codes. Results A total of 315 cases were discussed across all 5 sites, with most cases taking < 30 minutes to complete (210; 67%; Figure 1). The cases yielded 600 ICD-10 codes, of which 219 (36%) described an infection and 165 (27%) described other medical diagnoses (Figure 2). The number of ICD-10 codes per consult ranged from 1.0 (Sites A and C) to 3.5 (Site D). Overall, the most common infections discussed pertained to the respiratory tract (57/219, 26%) and skin and soft tissue (53/219, 24%); the most common pathogen code was for Enterococcus spp. (10/59, 17%) (Figure 3).Figure 1:Length of Time per ConsultFigure 2:Types of ICD-10 CodesFigure 3:ICD-10 Codes for Infections Conclusion Our results reveal notable differences in the diagnosis and procedure codes used across the 5 VASTs. In general, the VASTs address a similar array of infectious disease syndromes, suggesting that the observed differences may relate to how the ID experts approached coding. Further evaluations will assess the patients discussed and may consider further evaluation of coding practices used for telehealth. Disclosures Daniel J. Livorsi, MD, Merck: Grant/Research Support Robin L. Jump, MD, PhD, Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support