Problems of terminology and clinical coding of necrotizing fasciitis

Abstract

Purpose - to analyze the typical defects of the formulation of the diagnosis of necrotizing fasciitis (NF), to verify the lexically correct term NF, to develop proposals for the correct coding of NF according to ICD-10-AM.

Materials and methods. The medical records of 150 patients who during 1999-2021 were treated in two hospitals of Lviv City (Ukraine) for necrotizing fasciitis was analyzed. Compared diagnoses when referred to the hospital, preliminary and final clinical diagnoses, preoperative and postoperative diagnoses, recorded their statistical codes for ICD-10. An analysis of Ukrainian and Russian-language surgical publications available in Ukraine for the period from 1985 to 2021 on the keywords «surgical soft tissue infection», «necrotizing fasciitis», «soft tissue necrosis».

Results. In 142 (95.0%) of the 150 patients operated on for NF, the diagnosis was not correctly formulated during referral. Most often NF was directed and in the initial stages was treated under the guise of other diagnoses: «phlegmon», «erysipelas», «thrombophlebitis», «gangrene», «perianal abscess». NF was suspected by the surgeon prior to the first surgery only in 53 (35.33%) patients. In other cases, it was diagnosed intraoperatively or during repeated interventions. Codes corresponding to other forms of surgical infection were often used for statistical coding of NF. We also worked on lexical variants of the term «necrotizing fasciitis» in Ukrainian language.

Conclusions. It was worked out the most correct terminologically Ukrainian equivalent of the diagnosis «necrotizing fasciitis». For statistical coding of NF, it should be designated as the main active disease by code M72.6. The use of a unified term and statistical coding will allow in the future to form a single within the state diagnostic-related group for fair reimbursement of funds to health care providers for treated cases of NF.

The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.