Complication as Principle Diagnosis vs Sepsis as Principle Diagnosis

mdomineseymdominesey
edited May 2016 in CDI Talk Archive
I read somewhere that when a complication code is principle diagnosis, it is one the rare diagnoses that overrides Sepsis as principle when both are POA. Am I right in my recollection?

Does anybody have the coding clinic or coding guidelines reference handy for this scenario?

Thanks,

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

  • dvitalone1dvitalone1
    edited May 2016
    This is not correct from my understanding
    It depends on the complication code. When it is UTI due to indwelling Foley catheter then yes, it overrides the sepsis. But this is not always true.
    I so happen to be training with 3M right now and we just went over this today

    Dawn M. Vitalone, RN, CCDS
    Clinical Documentation Improvement Specialist
    Community Hospital
    Munster, IN
    219-513-2611
    dvitalone@comhs.org
  • ddouthitddouthit
    edited May 2016
    Mark,

    I have attached coding guidelines, is this what you are referring to?


    Sepsis due to a Postprocedural Infection

    (a) Documentation of causal relationship

    As with all postprocedural complications, code assignment is based on the provider's documentation of the relationship between the infection and the procedure.

    (b) Sepsis due to postprocedural infection

    In cases of postprocedural sepsis, the complication code, such as code 998.59, Other postoperative infection, or 674.3x, Other complications of obstetrical surgical wounds should be coded first followed by the appropriate sepsis codes (systemic infection code and either code 995.91or 995.92). An additional code(s) for any acute organ dysfunction should also be assigned for cases of severe sepsis.

    See Section see Section I.C.1.b.6 if the sepsis or severe sepsis results in postprocedural septic shock.

    (c) Postprocedural infection and postprocedural septic shock

    In cases where a postprocedural infection has occurred and has resulted in severe sepsis and postprocedural septic shock, the code for the precipitating complication such as code 998.59, Other postoperative infection, or 674.3x, Other complications of obstetrical surgical wounds should be coded first followed by the appropriate sepsis codes (systemic infection code and code 995.92). Code 998.02, Postoperative septic shock, should be assigned as an additional code. In cases of severe sepsis, an additional code(s) for any acute organ dysfunction should also be assigned.

    11) External cause of injury codes with SIRS

    Refer to Section I.C.19.a.7 for instruction on the use of external cause of injury codes with codes for SIRS resulting from trauma.

    12) Sepsis and Severe Sepsis Associated with Non-infectious Process

    In some cases, a non-infectious process, such as trauma, may lead to an infection which can result in sepsis or severe sepsis. If sepsis or severe sepsis is documented as associated with a ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 21 of 107



    non-infectious condition, such as a burn or serious injury, and this condition meets the definition for principal diagnosis, the code for the non-infectious condition should be sequenced first, followed by the code for the systemic infection and either code 995.91, Sepsis, or 995.92, Severe sepsis. Additional codes for any associated acute organ dysfunction(s) should also be assigned for cases of severe sepsis. If the sepsis or severe sepsis meets the definition of principal diagnosis, the systemic infection and sepsis codes should be sequenced before the non-infectious condition. When both the associated non-infectious condition and the sepsis or severe sepsis meet the definition of principal diagnosis, either may be assigned as principal diagnosis.

    See Section I.C.1.b.2.a. for guidelines pertaining to sepsis or severe sepsis as the principal diagnosis.

    Only one code from subcategory 995.9 should be assigned. Therefore, when a non-infectious condition leads to an infection resulting in sepsis or severe sepsis, assign either code 995.91 or 995.92. Do not additionally assign code 995.93, Systemic inflammatory response syndrome due to non-infectious process without acute organ dysfunction, or 995.94, Systemic inflammatory response syndrome with acute organ dysfunction.
    See Section I.C.17.g for information on the coding of SIRS du

    Dorie Douthit, RHIT,CCS
  • mdomineseymdominesey
    edited May 2016
    Can you ask 3M about this? It is a complication of a previous surgery (laceration causing a perf) then the patient came back, the perf was found and patient was septic too.

    Thanks Dawn!

    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
  • mdomineseymdominesey
    edited May 2016
    Yay Dorie!! Thanks so much - Fits my scenario exactly!

    MND


    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
  • dvitalone1dvitalone1
    edited May 2016
    Do they link the sepsis to the laceration/perf?

    [cid:image003.jpg@01CD90F4.5B74E5A0]
    Dawn M. Vitalone, RN, CCDS
    Clinical Documentation Improvement Specialist
    Community Hospital
    Munster, IN
    219-513-2611
    dvitalone@comhs.org
  • mdomineseymdominesey
    edited May 2016
    Yes! That is one thing that was done right - cause and effect. The surgeon doing the repair of the previous surgery's lac was not the same surgeon. I almost always have to query for cause and effect in this type of case - maybe the 2nd surgeon was all too happy to state the problem of the 1st surgeon?

    Thanks for your help!

    MND


    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
  • judithbatesjudithbates
    edited May 2016
    Mark,
    That is so typical that they will only state the cause and effect from an outside hospital!!!


    Judi Bates RN, BSN, CCDS
    Our Lady of Lourdes Medical Center
    CDI Specialist
    856-757-3161
    Beeper 66x2906
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