Complication of care sequencing

jlightfoot@marshallmedical.org

Pt admitted with a CAUTI POA, pneumonia and sepsis. Documentation supports that the sepsis was secondary to the UTI AND the pneumonia. The pneumonia required multiple IV abx changes, IV steroids and intubation secondary to acute respiratory failure.

I'm aware of the coding guideline regarding complications of care and secondary sepsis but what about if the sepsis is related to a separate diagnosis or in this case "possibly" secondary to the pneumonia?? Or if the CAUTI was an incidental find in a pt with say, an MI?

Does the complication of care code ALWAYS have to be Pdx or can we use the coding guidelines for when two or more diagnoses meet criteria for Pdx and sequence any of the diagnoses first?

Thanks,
Jillian Lightfoot RN
Clinical Documentation Specialist
Marshall Medical Center
Placerville, CA
(530) 626-2770 x6209
jlightfoot@marshallmedical.org

jlightfoot@marshallmedical.org

I forgot to mention, that yes, the UTI was also treated with IV abx. Thanks again for any guidance.

ssalinas

If the physician states that patient has sepsis due to CAUTI AND pneumonia, then I believe either 996.64 or 038.x could be the principal diagnosis. If the physician states sepsis due to CAUTI and possibly pneumonia, I would go with the complication or query for clarification. Was the respiratory failure due to the pneumonia or the sepsis? If it was due to the sepsis caused by pneumonia, then I believe the 038.x would be principal since we are now into severe sepsis.

If a patient comes with a MI and an incidental CAUTI is discovered, then the MI would be principal. If the patient comes in through ER with a condition that would not necessarily require IP admission but a CAUTI is discovered for which reason patient is admitted to IP status, then CAUTI would be principal.


The complication is not always the principal diagnosis. It depends on each individual situation.

Other thoughts anyone?

Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org

catladyrn

I think sometimes there is confusion regarding the sequencing rules for complications (and poisonings, as well). The guidelines don't state that the complication must be the principal diagnosis (unlike sepsis guidelines). They state simply that the complication is sequenced ahead of the manifestation, which is why a CAUTI causing sepsis results in the complication code going in front of the sepsis code (not to mention the specific guidance in the sepsis chapter). If another condition which is not a manifestation of the complication caused the admission, then that condition would be sequenced first unless there's yet another rule that overrides it, such as pregnancy.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System

jlightfoot@marshallmedical.org

Thank you for the input. You both validated my thoughts; I was pushing for the 038.9 based on the documentation and presentation. Ultimately our coder wouldn't go for the 038.9 Pdx and we billed with the 996.64 Pdx. You can't win them all! LOL