Sepsis & Meningitis

Unknown
in CDI Talk Archive
I have a patient admitted with sepsis r/o meningitis. The CSF has come back c/w acute bacterial meningitis.

Since the Official Coding Guidelines sequence sepsis before the localized infection is sepsis PDx (meaning meningitis is a localized infection)?



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).


Thanks for thoughts!



[cid:image001.png@01CFF73F.149122D0]

Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Menorah Medical Center
5721 W. 119th Street
Overland Park, Kansas 66209

Comments

  • catladyrncatladyrn
    When they talk about localized, they're talking about an infection that began in a specific location, such as pneumonia in the lung, cellulitis to the skin, etc., that progressed to the point of a systemic infection. So yes to your question, in that meningitis is originally localized to the CNS and then becomes systemic sepsis.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation, Core Measures and Outcomes
    Tanner Health System
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I agree that Infective Meningitis that has progressed to the point of a systemic infection (sepsis), is coded to sepsis as the principal diagnosis.

    I am perplexed by advice I find in the 2014 CDI Pocket Guide, pg3, stating that Meningitis may be the principal diagnosis in this situation. This seems counter to the logic correctly stated by Renee.



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

  • Unknown
    edited May 2016
    It will be interesting to see what the coder chooses when this patient is discharged. They do not have access to the Pocket Guide. . .


    Charlene

  • ddouthitddouthit
    edited May 2016
    According to the logic under DRG tips pg 49 of the 2014 CDI Pocket Guide, Alt DRG 94 Meningitis as an interrelated PDX with sepsis. Tips, "Most cases of meningitis are caused by bacteria or viruses that enter the bloodstream via the upper respiratory tract and then infect the meninges of the brain. Meningitis is not typically a localized infection that progresses to sepsis. Bacteremia or septicemia, when it occurs, usually precedes the meningitis. Because there is no underlying/localized infection, the two may be considered interrelated and either sequenced as PDX, although meningitis is likely to be the focus of the admission".

    As a coder I do not think I have ever sequenced meningitis over sepsis if both were present on admit. Something to ponder.


    Dorie Douthit RHIT,CCS
    AHIMA-Approved ICD-10-CM/PCS Trainer
    ddouthit@stmarysathens.org



  • Unknown
    edited May 2016
    Sepsis has the higher relative weight with MCC. Without they are similar weights.



  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Thanks, Dorie

    I am not sure I agree with the logic stated by this portion of the publication....

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Yes, but we must be consistent in our practice, regardless of relative weights. Sepsis is systemic.


    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




    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

Sign In or Register to comment.