RE: [EXTERNAL] RE: Flu with pneumonia, with Sepsis
Mild disagreement, if this is an influenza pneumonia I don't think you can use the 038.9 code since it is for unspecified septicemia. Per the guidance I get "Use this code when the diagnosis is identified as a "septicemia," but is not specified as to organism or type." It seems here you have a specified organism or type.
I will assume you have the sepsis linked to the pneumonia. If so you can use the 487.0 (Influenza with pneumonia) and 995.91 as a secondary diagnosis. If not, you need to get that documented.
My question is if the infection is causing the acute kidney injury, do you have severe sepsis (sepsis affecting another organ system)? It would be worth a query to confirm or remove that link.
Robert
Robert S. Hodges MSN, BSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VA Medical Center
1500 Weiss Street, ATTN PAS-136
Saginaw MI 48602
989-497-2500 x13101
Robert.Hodges2@va.gov
VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
I will assume you have the sepsis linked to the pneumonia. If so you can use the 487.0 (Influenza with pneumonia) and 995.91 as a secondary diagnosis. If not, you need to get that documented.
My question is if the infection is causing the acute kidney injury, do you have severe sepsis (sepsis affecting another organ system)? It would be worth a query to confirm or remove that link.
Robert
Robert S. Hodges MSN, BSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VA Medical Center
1500 Weiss Street, ATTN PAS-136
Saginaw MI 48602
989-497-2500 x13101
Robert.Hodges2@va.gov
VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens