‘Unspecified mycosis’ code often listed for patients positive for specific fungal disease
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Nearly half of patients who received a diagnosis code of “unspecified mycosis” had positive laboratory test results for a specific fungal disease, with the most common being invasive candidiasis, researchers found.
“Fungal diseases can cause serious illness and death, but we’re still learning about how many people in the U.S. are affected. The purpose of this study was to describe features of hospitalized patients who received a discharge diagnosis code of ‘unspecified mycosis’ to better understand why this code is used and what it means for fungal disease burden estimates,” Kaitlin Benedict, MPH, CDC epidemiologist, told Healio.
“Most fungal diseases have a specific discharge code. However, the code ‘unspecified mycosis’ is a commonly listed diagnosis code among people with fungal diseases. We don’t fully understand why patients receive this diagnosis code,” Benedict said.
Using data from the 2019-2021 PINC-AI Healthcare Database — a hospital-based all-payer database containing health care utilization, financial data, pharmacy data and microbiology laboratory data from a subset of hospitals — Benedict and colleagues identified underlying conditions, complications and specific fungal diseases using ICD-10 diagnosis codes, more specifically B49, which is used for “unspecified mycosis.”
Among the 1,881 hospitalizations with B49 codes, there were 1,788 patients from 149 hospitals with laboratory data available. Of these, ICU care occurred in 46.3% and in-hospital death occurred in 19.4%, with B49 being the primary discharge diagnosis for 2.9%.
According to the study, 50.9% of B49 hospitalizations had at least one positive fungal laboratory test, whereas 25.6% had a negative test and 23.4% did not receive a test at all.
Among those with at least one positive fungal test, Candida was the most common result (79.1%), although 65.1% came back positive for an unspecified fungus — of which 82.9% also had a positive result for Candida.
Additionally, B49 hospitalizations with at least one positive test more frequently involved older patients (mean 61.3 years vs. 59.6 years), longer hospitalizations (mean 21.5 days vs. 11.4 days), ICU care (62.3% vs. 29.6%), in-hospital death (27.5% vs. 10.9%) and systemic antifungal use (98.5% vs. 83.3%) compared with hospitalizations without a positive fungal laboratory test.
Among those with systemic antifungal use, echinocandins (76.6% vs. 45.9%) and fluconazole (46.1% vs. 36.7%) were the most commonly used.
“The amount of coding we see for ‘unspecified mycoses’ in hospital discharge databases may not be warranted given that about 40% of the hospitalizations in this analysis had a positive culture for invasive candidiasis, which is one of the most common fungal infections among hospitalized patients,” Benedict said.
“Health care providers need to pay careful attention to coding practices for candidiasis, as more accurate coding for fungal diseases would help make these types of hospital discharge database analyses more useful for public health decision-making,” she said
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