"Distributive Shock"

mdomineseymdominesey
edited May 2016 in CDI Talk Archive
I work directly for the Chief Medical Information Officer at my hospital. We discussed shock, hypotension, and the use of pressors in a post surgical patient.

In our discussion about the use of pressors in the ICU for post-surgical patients, he agrees that if a patient is on Levophed (Norepinephrine), then the patient has something more serious than "hypotension". He states that a patient with this type of shock is best described as one in "Distributive Shock". He states that the cause of this type of shock in a post-surgical patient is mostly likely due to vasodilation where the volume to fill becomes greater, thus, blood pressure drops. Levophed is used to help constrict the blood vessels and helps increase the blood pressure. Further, he describes this as "Distributive Shock due to a SIRS response from the stress of surgery".

Should this type of shock be clarified to "Post-operative shock" - 998.00? When using the most prevalent encoder, the logic tree takes you this way: Shock--> Surgical/Postoperative --> post-operative shock. This is a CC diagnosis. Or considering that this type of shock is caused by a SIRS response, should it be coded 785.52 - Septic shock even though an infection did not cause it.

Ok, what about when something happens because of the hypotension? What if the "shock" caused Kidney Injury (AKI caused by hypotension is usually ATN). Then we are talking "organ damage" caused by the shock. Do we just code the organ damage and the shock as separate codes? In Septic Shock, the Septic Shock "stacks" on top of "Sepsis" or "Severe Sepsis" offering an additional MCC on top of the one for the Sepsis diagnosis.

Thanks so much

Mark


Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695
W: 202.660.6782
F: 202.537.4477
mdominesey@sibley.org
http://www.sibley.org

Comments

  • catladyrncatladyrn
    Distributive shock codes to 998.00, with or without clarification. If it's not septic, it's not sepsis. SIRS is an inflammatory response that can occur with or without sepsis, so if the physician states that it's distributive shock due to SIRS, but doesn't indicate the presence of infection--which appears to be the case in your scenario--you can't and shouldn't take it to septic shock.

    AKI is a stand-alone diagnosis, regardless of cause.

    Hope that helps.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS, CDIP
  • kmaritankmaritan
    edited May 2016
    It appears from the ICD 9 code book that 998.00 is post operative shock. You can have distributive shock without being post op. Per the coders here and using the Encoder, there is no choice for distributive shock (the Encoder will not allow you to spell distributive) with the only choice being "other specified shock" which is 785.59, an MCC. "Shock unspecified" is 785.50, a CC. This seems to make sense that shock alone documented is a CC while specified as distributive it is an MCC.

    Karen Maritano, R. N.
    Clinical Documentation Specialist
    Legacy Health
    Portland, Oregon
    503-413-7154


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  • catladyrncatladyrn
    The original question was about postoperative patients. While there is no definitive code yet for distributive shock, in the absence of sepsis, in a postoperative patient the most reasonable code, IMO, is 998.00.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS, CDIP
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