SIRS with appendicitis
Question for you surgery CDI's:
I have a surgeon who has had several patients that meet criteria for "SIRS" related to their appendicitis (high WBC, tachycardic, etc...). He is documenting "SIRS related to appendicitis". Patient put on Zosyn. No perforation. Discharged day after surgery. -- On paper they really do not look that "sick" to me, but they do have SIRS criteria and an underlying infection source. Is it appropriate to code these as Septicemia, or not? In ICD 10 it doesn't look like you can code SIRS with underlying infection to Sepsis.
Thank you for any help!
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I have a surgeon who has had several patients that meet criteria for "SIRS" related to their appendicitis (high WBC, tachycardic, etc...). He is documenting "SIRS related to appendicitis". Patient put on Zosyn. No perforation. Discharged day after surgery. -- On paper they really do not look that "sick" to me, but they do have SIRS criteria and an underlying infection source. Is it appropriate to code these as Septicemia, or not? In ICD 10 it doesn't look like you can code SIRS with underlying infection to Sepsis.
Thank you for any help!
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
Comments
----- Original Message -----
From: "CDI Talk"
To: gwojo@wowway.com
Sent: Thursday, June 11, 2015 1:53:00 PM
Subject: [cdi_talk] SIRS with appendicitis
Question for you surgery CDI’s:
I have a surgeon who has had several patients that meet criteria for “SIRS” related to their appendicitis (high WBC, tachycardic, etc…). He is documenting “SIRS related to appendicitis”. Patient put on Zosyn. No perforation. Discharged day after surgery. -- On paper they really do not look that “sick” to me, but they do have SIRS criteria and an underlying infection source. Is it appropriate to code these as Septicemia, or not? In ICD 10 it doesn’t look like you can code SIRS with underlying infection to Sepsis.
Thank you for any help!
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
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You are correct that in ICD-10, they have to say sepsis rather than SIRS due to infection if they want sepsis to be coded.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System
When we see charts with SIRS due to an infection we Query.
GG
Greta Goodman, CCDS
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 3:36 PM
To: Goodman, Greta
Subject: re:[cdi_talk] SIRS with appendicitis
I'm not quite seeing where you have evidence of an underlying infection. Appendicitis isn't necessarily an infection on its own. It is, however, an inflammatory process that would lend itself to a SIRS diagnosis.
You are correct that in ICD-10, they have to say sepsis rather than SIRS due to infection if they want sepsis to be coded.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP Director, Clinical Documentation Tanner Health System
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Copyright 2013
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----- Original Message -----
From: "CDI Talk"
To: gwojo@wowway.com
Sent: Thursday, June 11, 2015 2:35:40 PM
Subject: re:[cdi_talk] SIRS with appendicitis
I'm not quite seeing where you have evidence of an underlying infection. Appendicitis isn't necessarily an infection on its own. It is, however, an inflammatory process that would lend itself to a SIRS diagnosis.
You are correct that in ICD-10, they have to say sepsis rather than SIRS due to infection if they want sepsis to be coded.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System
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Copyright 2013
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----- Original Message -----
From: "CDI Talk"
To: gwojo@wowway.com
Sent: Thursday, June 11, 2015 2:39:55 PM
Subject: RE: re:[cdi_talk] SIRS with appendicitis
I wouldn’t code sepsis unless they clearly documented Sepsis.
When we see charts with SIRS due to an infection we Query.
GG
Greta Goodman, CCDS
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 3:36 PM
To: Goodman, Greta
Subject: re:[cdi_talk] SIRS with appendicitis
I'm not quite seeing where you have evidence of an underlying infection. Appendicitis isn't necessarily an infection on its own. It is, however, an inflammatory process that would lend itself to a SIRS diagnosis.
You are correct that in ICD-10, they have to say sepsis rather than SIRS due to infection if they want sepsis to be coded.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP Director, Clinical Documentation Tanner Health System
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication may contain personal patient health care information and is protected by federal law and other statutory protections. If you are not the intended recipient or the individual responsible for delivering the e-mail to the intended recipient, please be advised that you have received this e-mail in error and that any use, dissemination, forwarding, printing, or copying of this e-mail or any attached files is strictly prohibited. If you have received this e-mail in error, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Virginia Hospital Center -Arlington's Information Systems Department @703-558-6566.
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Copyright 2013
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-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 2:36 PM
To: Hoffmeister, Loretta
Subject: re:[cdi_talk] SIRS with appendicitis
I'm not quite seeing where you have evidence of an underlying infection. Appendicitis isn't necessarily an infection on its own. It is, however, an inflammatory process that would lend itself to a SIRS diagnosis.
You are correct that in ICD-10, they have to say sepsis rather than SIRS due to infection if they want sepsis to be coded.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP Director, Clinical Documentation Tanner Health System
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System
I would question; Did we start early goal-directed therapy when they came into ED? IVF, broad spec abx, 02 etc. Often, we do see short length of stays with SIRS if we start that early goal directed therapy early enough!
Otherwise, if they had indicators and SIRS is documented and carried through the chart, then you would be asking "are you sure?" to a provider (which wouldn't go over very well). IF it wasn't carried through the chart and was not on the DC summary, THEN I would ask, "after study and patient response, please clarify if the SIRS ruled out, or resolved based on what was treated, and monitored?"
Hope that helps! BY NOT CODING IT, YOU WOULD BE BASICALLY PRACTICING WITHOUT A LICENSE? RIGHT?
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[Description: Description: CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 12:53 PM
To: Bovard, Juli
Subject: [cdi_talk] SIRS with appendicitis
Question for you surgery CDI's:
I have a surgeon who has had several patients that meet criteria for "SIRS" related to their appendicitis (high WBC, tachycardic, etc...). He is documenting "SIRS related to appendicitis". Patient put on Zosyn. No perforation. Discharged day after surgery. -- On paper they really do not look that "sick" to me, but they do have SIRS criteria and an underlying infection source. Is it appropriate to code these as Septicemia, or not? In ICD 10 it doesn't look like you can code SIRS with underlying infection to Sepsis.
Thank you for any help!
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
Juli
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 1:54 PM
To: Bovard, Juli
Subject: RE:[cdi_talk] SIRS with appendicitis
If the provider says "SIRS due to infection", you code the SIRS. If they didn't have indicators, then a query would be appropriate for what their indicators were!
I would question; Did we start early goal-directed therapy when they came into ED? IVF, broad spec abx, 02 etc. Often, we do see short length of stays with SIRS if we start that early goal directed therapy early enough!
Otherwise, if they had indicators and SIRS is documented and carried through the chart, then you would be asking "are you sure?" to a provider (which wouldn't go over very well). IF it wasn't carried through the chart and was not on the DC summary, THEN I would ask, "after study and patient response, please clarify if the SIRS ruled out, or resolved based on what was treated, and monitored?"
Hope that helps! BY NOT CODING IT, YOU WOULD BE BASICALLY PRACTICING WITHOUT A LICENSE? RIGHT?
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[Description: Description: CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 11, 2015 12:53 PM
To: Bovard, Juli
Subject: [cdi_talk] SIRS with appendicitis
Question for you surgery CDI's:
I have a surgeon who has had several patients that meet criteria for "SIRS" related to their appendicitis (high WBC, tachycardic, etc...). He is documenting "SIRS related to appendicitis". Patient put on Zosyn. No perforation. Discharged day after surgery. -- On paper they really do not look that "sick" to me, but they do have SIRS criteria and an underlying infection source. Is it appropriate to code these as Septicemia, or not? In ICD 10 it doesn't look like you can code SIRS with underlying infection to Sepsis.
Thank you for any help!
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
________________________________
Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
If the patient went home the next day, they probably weren't septic.
However, the patient might have had SIRS and that would be an MCC. If you see an overuse of this term by the MD, that would be something you might want to have your advisor (assuming you have one) take a look at. If a pt has two pulses over 90 and one elevated wbc, that would be a red flag to me versus a pt with persistent symptoms needing increased resources/close monitoring, etc..
Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013
I understand being cautious with what coded, and queried for, that's why we look at the "whole picture" of vital trends, continued documentation, treatment and monitoring. Again, early goal directed therapy can keep a SIRS patient from becoming septic. Our sepsis coordinator does a great job with the SEPSIS alerts, and screenings in ED etc. I would only query with STRONG indicators, treatment and monitoring for the process. But under the circumstances of a provider stating SIRS due to an infection, you cannot just ignore it. It has to be clarified as infectious or non if it isn't. We don't get to choose what and what not to code.