Sepsis/SIRS order for coding
I have a sepsis issue---
I'll state as fact- what I think so correct me where I am wrong---
the coding guidelines (i'm referring to an oct 2010-so maybe something inaccurate?) state for coding sepsis,sirs,severe sepsis and we have found the encoder leads us the same way---
i)The code for the underlying cause (such as infection or trauma) must be sequenced before the code from the subcategory 995.9 systemic response syndrome
SO HOW IS UTI WITH SEPSIS CODED??
We( CDI) thought this was telling us the UTI should be PDX and the sepsis secondary- which would mcc the uti.
A coder just told me the sepsis 99% of the time is sequenced first and the UTI would be coded secondary. She referred me to CODING CLINIC 2003 quarter 4. Which does seem to say that---stating the sepsis code itself infers a progression of an infection into the systemic. (thus coding sepsis first and uti second).
MY TWO QUESTION NOW ARE:
1. isn't coding clinic a guideline but coding rules are the"gospel"??
2. the guidelines I looked at were 2010...wouldn't that supersede a coding clinic from 9 years ago??
Or am I just missing something???
I appreciate any help.
Ann
I'll state as fact- what I think so correct me where I am wrong---
the coding guidelines (i'm referring to an oct 2010-so maybe something inaccurate?) state for coding sepsis,sirs,severe sepsis and we have found the encoder leads us the same way---
i)The code for the underlying cause (such as infection or trauma) must be sequenced before the code from the subcategory 995.9 systemic response syndrome
SO HOW IS UTI WITH SEPSIS CODED??
We( CDI) thought this was telling us the UTI should be PDX and the sepsis secondary- which would mcc the uti.
A coder just told me the sepsis 99% of the time is sequenced first and the UTI would be coded secondary. She referred me to CODING CLINIC 2003 quarter 4. Which does seem to say that---stating the sepsis code itself infers a progression of an infection into the systemic. (thus coding sepsis first and uti second).
MY TWO QUESTION NOW ARE:
1. isn't coding clinic a guideline but coding rules are the"gospel"??
2. the guidelines I looked at were 2010...wouldn't that supersede a coding clinic from 9 years ago??
Or am I just missing something???
I appreciate any help.
Ann
Comments
This is my understanding at least....
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
as fungal) is the principal code - this is consistent with the most
recent advice per the Official guidelines and issues of Coding Clinic
Paul Evans, RHIA, CCDS
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Sequencing sepsis and severe sepsis
(a) Sepsis and severe sepsis as principal diagnosis
If sepsis or severe sepsis is present on admission, and meets the definition of principal diagnosis, the systemic infection code (e.g., 038.xx, 112.5, etc) should be assigned as the principal diagnosis, followed by code 995.91, Sepsis, or 995.92, Severe sepsis, as required by the sequencing rules in the Tabular List. Codes from subcategory 995.9 can never be assigned as a principal diagnosis. A code should also be assigned for any localized infection, if present.
If the sepsis or severe sepsis is due to a postprocedural infection, see Section I.C.1.b.10 for guidelines related to sepsis due to postprocedural infection.
(b) Sepsis and severe sepsis as secondary diagnoses
When sepsis or severe sepsis develops during the encounter (it was not present on admission), the systemic infection code and code 995.91 or 995.92 should be assigned as secondary diagnoses.
(c) Documentation unclear as to whether sepsis or severe sepsis is present on admission
Sepsis or severe sepsis may be present on admission but the diagnosis may not be confirmed until sometime after admission. If the documentation is not clear
ICD-9-CM Official Guidelines for Coding and Reporting
Effective October 1, 2011
Page 18 of 107
whether the sepsis or severe sepsis was present on admission, the provider should be queried.
3) Sepsis/SIRS with Localized Infection
If the reason for admission is both sepsis, severe sepsis, or SIRS and a localized infection, such as pneumonia or cellulitis, a code for the systemic infection (038.xx, 112.5, etc) should be assigned first, then code 995.91 or 995.92, followed by the code for the localized infection. If the patient is admitted with a localized infection, such as pneumonia, and sepsis/SIRS doesn't develop until after admission, see guideline I.C.1.b.2.b).
If the localized infection is postprocedural, see Section I.C.1.b.10 for guidelines related to sepsis due to postprocedural infection.
Note:
4) Bacterial Sepsis and Septicemia The term urosepsis is a nonspecific term. If that is the only term documented then only code 599.0 should be assigned based on the default for the term in the ICD-9-CM index, in addition to the code for the causal organism if known.
In most cases, it will be a code from category 038, Septicemia, that will be used in conjunction with a code from subcategory 995.9 such as the following:
(a) Streptococcal sepsis
If the documentation in the record states streptococcal sepsis, codes 038.0, Streptococcal septicemia, and code 995.91 should be used, in that sequence.
(b) Streptococcal septicemia
If the documentation states streptococcal septicemia, only code 038.0 should be assigned, however, the provider should be queried whether the patient has sepsis, an infection with SIRS.
5) Acute organ dysfunction that is not clearly associated with the
Dorie Douthit, RHIT,CCS
ddouthit@stmarysathens.org