We call these and ANTI-query and specifically ask the provider to "clarify the clinical indicators used from RECOGNIZED criteria for the documented diagnosis of Sepsis"... \
I would like to see your I-10 Sepsis query and your "Anti" query if you are willing to share. I would like to compare it to the one we have been using. Thank you.
afeighner@bvhealthsystem.org
Amber L. Feighner RN MSN CCDS Clinical Documentation Improvement Analyst Blanchard Valley Health System 1900 South Main Street Findlay, Ohio 45840 419-425-5787
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Can you send to angela.clayberg@MWHC.com too?
Respectfully,
Angela Clayberg, BA, RN Clinical Documentation Improvement Manager 1201B Sam Perry Blvd., Suite 210 Fredericksburg, Virginia 22401 angela.clayberg@MWHC.com 540-741-4093
1. SIRS due to infectious process without sepsis...? This is confusing wouldn't the by definition BE sepsis? If they select that than isn't coding in a worse quandary?
2. Would it be useful to include SIRS due to non-infectious process WITH acute organ dysfunction?
We clarify this as you CAN have SIRS without Sepsis-and still have an infection. In ICD-10 you would then take the localized infection as PDX and NOT sepsis. Our coders actually believe it HELPS them more clearly!
We have a query that is just for non-infectious SIRS with acute organ dysfunction. We thought it would be prudent to keep them separated to avoid confusion.
Kathleen Benson RN, BSN, CCDS Supervisor, Clinical Documentation Integrity UWHealth University of Wisconsin Hospital Office Location: University Crossing, 749 University Row, Suite 200 Mailing Location: 600 Highland Avenue, Mail Code 9920 Madison, WI 53792-9475 608-516-5638 kbenson@uwhealth.org
You certainly can have SIRS d/t noninfectious source as well as an infection (ex SIRS 2/2 alcoholic pancreatitis in a patient who also has a UTI). But this would not be 'SIRS 2/2 infectious process without sepsis'. This would be SIRS 2/2 non-infectious process. I too am confused by the wording. By definition, SIRS 2/2 infectious process is sepsis.
Thanks!
Katy Good, RN, BSN, CCDS, CCS Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com Cell: 928.814.9404
Okay I ran it and then you just end up with the infection. Interesting. So you Have to ask it if they say sirs with pneumonia? If that's been an obvious message in training I missed that!! I'll have to watch charts closer for that I think I'd just have gone there based on what I knew from Icd 9. Thanks!
Currently in I-10, the term SIRS is classified solely as associated with Non-Infectious Source. If am MD responds a pt has 'SIRS 2/2 UTI', there is not code for the SIRS, and we can no longer assign this to a form of SEPSIS.
Ann: Asking for "SIRS" w/ PNA will not be particularly helpful in I-10 given the term SIRS w/ PNA no longer codes to Sepsis. See the Guidelines I just sent? In a hurry now, but, if pt meets criteria for SEPSIS, we'd need to query for SEPSIS.
I don't think I would ask that. What I think I'm taking away here is IF THE DOC states SIRS WITH PNA - I'd have to query with or without sepsis.
I think I get the non-infectious part and the no urosepsis code but the above is new to me. To NEED to query the distinction in I-10... Hope I'm explaining(and getting!) the nuances!
You've got it Whereas SIRS 2/2 PNA was coded as sepsis in I-9, it would now be coded as PNA in I-10. You need to query for sepsis if the provider documents SIRS 2/2 any infectious process in order to accurately capture the patients clinical presentation.
Katy Good, RN, BSN, CCDS, CCS Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com Cell: 928.814.9404
In 3M, and for coding if you have SIRS, you can have "SIRS due to infection WITHOUT sepsis" . In I-9 SIRS w infection automatically defaulted to Sepsis. However in I-10 SIRS with an infection does not automatically default to sepsis...., just codes to the localized infection..... As our providers always tell us, you can have SIRS without sepsis and still have an infection. We worked long and hard with providers on this and it begs the question; "are all patients with 2 or more SIRS criteria septic?" "can a patient be septic without having 2 SIRS criteria?"
Our providers often document "SIRS due to UTI/PNA etc (infection) WITHOUT sepsis", (and they had many long and hard discussions about making sure the query asked those questions). For OUR institution-this is what works for us and what was desired.
ANN-and yes, that is what I am eluding to-if the provider documents SIRS with PNA (especially if they have clinical criteria for SIRS) I query for SEPSIS.
Good for you, Katy! 95% of patients seen in EDs with an infection and 2 of the 4 SIRS criteria go home on oral antibiotics. Acute otitis media kids go home on amoxicillin. 14 year olds get their appendixes out and go home in 24 hours. You should NOT ask for sepsis if the patient obviously doesn't have it. Way to go!
Robert S. Gold, MD CEO, DCBA, Inc 4611 Brierwood Place Atlanta, GA 30360 (770) 216-9691 (Office) (404) 580-0204 (Cell)
Please let me clarify-we DO NOT ask for sepsis just because the provider documents SIRS with infection. We carefully review for clinical indicators, treatment, sepsis pathways, sepsis screen, lactic acid levels, etc. On the flip side, if they do have recognized clinical indicators and are documenting "SIRS with infection (UTI, PNA etc)..the coders nor I can diagnose the patient (nor do the providers want us too). So, yes we would ask the provider to clarify if there was sepsis-especially if they don't document support for-or related to why any one of the criteria used for SIRS/sepsis is not associated with another process. (ie RR elevated due to COPD exacerbation etc)
I realize many patients who come in with 2 or more SIRS indicators and an infection are not septic.
I feel like I am coming across incorrectly or misunderstood. IT is always our best practice to make the chart complete for quality-not reimbursement or DRG driven. It is not my job to diagnose patients, but to help clarify ambiguous diagnoses from providers. SO, yes, if a patient comes in admitted with a UTI (few or no co-morbidities) and SIRS criteria and DIES- you bet that I am going to be looking FOR Sepsis. (and, yes this does happen here... and everywhere I am assuming).
Interesting. I have never heard that you can truly have SIRS 2/2 infection and it not have sepsis. Our MD's have not brought this forward. You may have 'SIRS criteria' met with infection (half our patients come in with altered vital signs and some sort of infection, they are not all septic) and the provider may determine this is not Sepsis. I realize that just because you have tachycardia and tachypnea with a UTI, does not necessarily mean that the tachycardia and tachypnea are indicative of sepsis. There may be another reason clinically for the alteration in vital signs (this is why we query to clarify). But in my understanding this would also not be SIRS either because a systemic inflammatory response is not the cause of the altered vital signs. Both SIRS and Sepsis refer to a systemic inflammatory response. My understanding of the difference is what the underlying cause is. If the underlying cause is infectious, my hospital is defining this as sepsis. I would be very curious about the reference for SIRS 2/2 infection not being sepsis. We are currently in the process of creating our institutional definitions and Care Process Model regarding Sepsis in light of the new Sepsis Core Measure and (so far) this has not come up. The literature being used by my facility (surviving sepsis, UpToDate, etc) seems to support SIRS with infectious source as being sepsis. I would love to bring that alternative source forward if possible.
Anyways, I feel like I am talking in circles and I apologize for that. I learn something new every day....
Katy Good, RN, BSN, CCDS, CCS Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com Cell: 928.814.9404
I agree with you Juli, we also are looking for those supporting clinical indicators. For the purpose of this conversation I have been assuming that the clinical indicators are truly there to support the dx, otherwise we would be looking at an entirely separate issue. Also, if we are following the 'best-practice' ACDIS guidelines, our query is not suggesting any particular response. We are solely recognizing an area requiring clarification, not suggesting that a particular dx be made. If a patient with a UTI is being admitted as an Inpatient (most patients with UTI/PNA/Etc can be treated as an outpatient), with elevated WBC's, fever, and tachycardia and SIRS 2/2 UTI is documented (or if just the UTI was documented) I believe a query for sepsis is indicated. There is definitely a possibility that the provider who is face-to-face with the patient, with knowledge of their medical history, and credentials as a diagnostician may determine that this is not sepsis but rather is simply a UTI. It is their job to diagnose. But I consider it my job to ask the question.
Katy Good, RN, BSN, CCDS, CCS Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com Cell: 928.814.9404
I don't think any of us are trying to 'game the system' or o/w act in a manner not entirely consistent with Best Practice. However, the language around this issue can be tricky. Also, the change in coding logic from I-9 to I-10 means we all need to examine the technical issues around coding (again).
No implications intended that anyone was trying to pull a trick, game etc. I know we are all in the same quandaries and all on the same team (so to speak). This site is helpful to us all....
I have been on the Sepsis committee for several years as we have had our own organizational Sepsis project to reduce mortality from Sepsis. You have to understand that the Medical staff here felt that the new Sepsis core measure cast a much wider net for the diagnosis of Sepsis but CMS set the core measure and expected quality of treatment as it is delineated by them. It does not mean that the physicians agree with it. We all receive out reimbursement from Medicare and the Core measure is one way for CMS to determine the quality of care expected by our major payer-Medicare. It is what it is. Our query is based on that core measure.
Mary L Snook RN-BC Clinical Documentation Improvement Specialist Fairfield Medical Center Lancaster, Ohio 43130 740-689-4443 snook@fmchealth.org
We too have a Sepsis committee and Sepsis coordinator with whom we work and it is INTERESTING for the CDI... With the new measures and criteria related to this diagnosis (LA >4) .... we now query more for "what are your clinical indicators to support the diagnosis of Sepsis from the recognized criteria"...... we call it an "anti-query".
Many providers are now documenting sepsis/ severe sepsis JUST and solely because of a LA > 4, with no other clinical criteria for SIRS/SEPSIS. (with infection).
Comments
Juli
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......"
I would like to see your I-10 Sepsis query and your "Anti" query if you are willing to share. I would like to compare it to the one we have been using. Thank you.
afeighner@bvhealthsystem.org
Amber L. Feighner RN MSN CCDS
Clinical Documentation Improvement Analyst
Blanchard Valley Health System
1900 South Main Street
Findlay, Ohio 45840
419-425-5787
Kim Williams, RN
Clinical Documentation Specialist
Revenue Management Department
kwilliams@halifaxrmc.org
(252) 535-8154
(252) 535-8937 fax
Debbie
dwhite@tfhd.com
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Can you send to angela.clayberg@MWHC.com too?
Respectfully,
Angela Clayberg, BA, RN
Clinical Documentation Improvement Manager
1201B Sam Perry Blvd., Suite 210
Fredericksburg, Virginia 22401
angela.clayberg@MWHC.com
540-741-4093
Cstukenberg@fhn.org.
Thanks
Content-Type: text/plain; charset=UTF-8
Me too. susan.stanek@bannerhealth.com
*Susan L Stanek* *RN, BSN*
*"Some people change their ways when they see the light, others when they
feel the heat." Caroline Schoeder*
vleadbetter@cmcvtx.org
Thanks,
Vickie Leadbetter
I would also like this information.
dee.banet@nortonhealthcare.org
Thanks
Dee
arozhkovskaya@mhs.net
Thanks!!!
I would also like this information
Thanks Corrine
ccbyrd@mdanderson.org
Thanks all,
Brian
Kathleen Benson RN, BSN, CCDS
Supervisor, Clinical Documentation Integrity
UWHealth University of Wisconsin Hospital
Office Location: University Crossing, 749 University Row, Suite 200
Mailing Location: 600 Highland Avenue, Mail Code 9920
Madison, WI 53792-9475
608-516-5638
kbenson@uwhealth.org
Juli
Thanks for sharing query. I had two questions.
1. SIRS due to infectious process without sepsis...? This is confusing wouldn't the by definition BE sepsis? If they select that than isn't coding in a worse quandary?
2. Would it be useful to include SIRS due to non-infectious process WITH acute organ dysfunction?
Thanks,
Ann
Sent from my iPhone
We clarify this as you CAN have SIRS without Sepsis-and still have an infection. In ICD-10 you would then take the localized infection as PDX and NOT sepsis. Our coders actually believe it HELPS them more clearly!
Juli
Kathleen Benson RN, BSN, CCDS
Supervisor, Clinical Documentation Integrity
UWHealth University of Wisconsin Hospital
Office Location: University Crossing, 749 University Row, Suite 200
Mailing Location: 600 Highland Avenue, Mail Code 9920
Madison, WI 53792-9475
608-516-5638
kbenson@uwhealth.org
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Ann
>
Fundamental change in I-10.
[cid:image001.png@01D11D2B.BB562800]
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.org
Paul Evans, RHIA, CCS, CCS-P, CCDS
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.org
I don't think I would ask that. What I think I'm taking away here is IF THE DOC states SIRS WITH PNA - I'd have to query with or without sepsis.
I think I get the non-infectious part and the no urosepsis code but the above is new to me. To NEED to query the distinction in I-10... Hope I'm explaining(and getting!) the nuances!
Thanks!
Ann
Whereas SIRS 2/2 PNA was coded as sepsis in I-9, it would now be coded as PNA in I-10. You need to query for sepsis if the provider documents SIRS 2/2 any infectious process in order to accurately capture the patients clinical presentation.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
As our providers always tell us, you can have SIRS without sepsis and still have an infection. We worked long and hard with providers on this and it begs the question;
"are all patients with 2 or more SIRS criteria septic?"
"can a patient be septic without having 2 SIRS criteria?"
Our providers often document "SIRS due to UTI/PNA etc (infection) WITHOUT sepsis", (and they had many long and hard discussions about making sure the query asked those questions). For OUR institution-this is what works for us and what was desired.
ANN-and yes, that is what I am eluding to-if the provider documents SIRS with PNA (especially if they have clinical criteria for SIRS) I query for SEPSIS.
Juli
Paul Evans, RHIA, CCS, CCS-P, CCDS
Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
(770) 216-9691 (Office)
(404) 580-0204 (Cell)
Deanne Wilk, BSN, RN, CCDS, CCS
AHIMA approved ICD-10-CM/PCS Trainer
Clinical Documentation Improvement and Inpatient Coding Manager
HIMS Department
Wellspan Good Samaritan Hospital
4th & Walnut Sts
Lebanon, PA 17042
dwilk@gshleb.org
Phone: 717-270-7582
Cell: 717-580-1436
I realize many patients who come in with 2 or more SIRS indicators and an infection are not septic.
I feel like I am coming across incorrectly or misunderstood.
IT is always our best practice to make the chart complete for quality-not reimbursement or DRG driven. It is not my job to diagnose patients, but to help clarify ambiguous diagnoses from providers. SO, yes, if a patient comes in admitted with a UTI (few or no co-morbidities) and SIRS criteria and DIES- you bet that I am going to be looking FOR Sepsis. (and, yes this does happen here... and everywhere I am assuming).
Juli
Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
(770) 216-9691 (Office)
(404) 580-0204 (Cell)
I would be very curious about the reference for SIRS 2/2 infection not being sepsis. We are currently in the process of creating our institutional definitions and Care Process Model regarding Sepsis in light of the new Sepsis Core Measure and (so far) this has not come up. The literature being used by my facility (surviving sepsis, UpToDate, etc) seems to support SIRS with infectious source as being sepsis. I would love to bring that alternative source forward if possible.
Anyways, I feel like I am talking in circles and I apologize for that. I learn something new every day....
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Also, if we are following the 'best-practice' ACDIS guidelines, our query is not suggesting any particular response. We are solely recognizing an area requiring clarification, not suggesting that a particular dx be made. If a patient with a UTI is being admitted as an Inpatient (most patients with UTI/PNA/Etc can be treated as an outpatient), with elevated WBC's, fever, and tachycardia and SIRS 2/2 UTI is documented (or if just the UTI was documented) I believe a query for sepsis is indicated. There is definitely a possibility that the provider who is face-to-face with the patient, with knowledge of their medical history, and credentials as a diagnostician may determine that this is not sepsis but rather is simply a UTI. It is their job to diagnose. But I consider it my job to ask the question.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
The subject did clarify something for me. My intent was not pulling a trick it was understanding the change in a needed query in ICD 10.
Thanks.
Ann
>
Paul Evans, RHIA, CCS, CCS-P, CCDS
No implications intended that anyone was trying to pull a trick, game etc. I know we are all in the same quandaries and all on the same team (so to speak). This site is helpful to us all....
Juli
Mary L Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
Lancaster, Ohio 43130
740-689-4443
snook@fmchealth.org
Many providers are now documenting sepsis/ severe sepsis JUST and solely because of a LA > 4, with no other clinical criteria for SIRS/SEPSIS. (with infection).
Job security!!!!!!