Question about Neoplasms
Patient admitted for Peritoneal abscess due to malignant neoplasm of peritoneum. What is the appropriate sequencing? I am trying to find the correct coding clinic.
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:00 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks for sharing Paul
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:56 AM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks so much Paul. You confirmed my belief that I need provider documentation in order to support this connection. I have shared your thorough summary with my CDS's and coders.
Judy
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
[cid:image007.jpg@01D13BFC.E7460C60]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:34 PM
To: Riley, Judith
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Very complicated topic, and one that probably would take much communication to cover completely, but I have some notes on this topic.
I do agree that the 'organ dysfunctions' stated in the code book are NOT all-inclusive...this is only a partial listing. As one example, a type II AMI 2/2 to sepsis is not listed as an acute organ dysfunction associated with Severe Sepsis. Further, the coding conventions do not make a distinction between an organ "failure' and an organ 'dysfunction' and dysfunctions that do not rise to the level may be present in some patients w/ severe sepsis.
I made my notes on this topic prior to the conversion to I-10 guidelines.
"Surviving Sepsis" does include ileus as consequence of sepsis, as below from 2012 publication, p 6, Diagnostic Criteria.
[cid:image008.png@01D13BFC.E7460C60]
My current practice and philosophy, modify for implementation of I-10.
* Physician documentation is the basis for all coding. The recognition and management of Severe Sepsis is a difficult task that is the responsibility of physicians.
* Sepsis causing Multiple Organ Dysfunction Syndrome is coded as Severe Sepsis.
* Severe sepsis generally refers to sepsis with associated acute organ dysfunction (e.g., oliguria, hypoxemia, lactic acidosis, altered cerebral function, hypoperfusion, and hypotension).
* Severe sepsis requires additional code(s) for the associated acute organ dysfunction(s)-10. If a patient has sepsis with multiple organ dysfunctions, follow the instructions for coding severe sepsis.
* For patients with documentation of severe sepsis, the code for the systemic infection should be sequenced first, followed by code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction (Severe Sepsis).
* If it is unclear that the documented organ dysfunction or failure is due to sepsis, then a query should be rendered. With the exception of the term Septic Shock, the physician must clearly link the organ dysfunction to the sepsis.
* Associated organ dysfunctions or failures that are a manifestation of severe sepsis are coded to fully report the complexity and associated severity of illness and risk of mortality of the severe sepsis.
* If a documented acute organ dysfunction implies a more severe illness, if the clinical circumstances warrant it, a concurrent or retrospective communication should be initiated to determine what language best describes the patient's conditions so that appropriate ICD-9-CM codes may be assigned.
ICD-9-CM Official Coding Guidelines
AHA Coding Clinic
If a physician documents SIRS due to an infection and the criteria for sepsis is met, a query to determine if the patient has sepsis is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a patient meets the criteria for sepsis but the physician hasn't documented it, a query is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a physician documents sepsis but its clinical validity is questionable, a query is required
- Coding Clinic, 1st Quarter, 2012, page 19
"Severe sepsis is associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion/organ dysfunction may include, but is not limited to lactic acidosis, oliguria, and/or acute alteration in mental status."
- Coding Clinic(r) for ICD-9-CM, 2Q 2000, Volume 17, Number 2, Pages 3-7
ICD-9-CM Coding Rules applicable to Sepsis
The ICD-9-CM Official Guidelines and Coding Clinic for ICD-9-CM, official advice referable to ICD-9-CM, offer explicit advice regarding code assignment for patients documented to have sepsis and severe sepsis, assuming that the patient has these conditions and that these have been consistently and completely documented by a treating provider.
The ICD-9-CM Index to Diseases classifies sepsis and severe sepsis as follows:
................. Sepsis (generalized) 995.91
With (emphasis added)
abortion - see Abortion, by type, with sepsis
acute organ dysfunction (emphasis added) 995.92
ectopic pregnancy (see also categories 633.0-633.9) 639.0
molar pregnancy (see also categories 630-632) 639.0
multiple organ dysfunction (emphasis added) (MOD) 995.92
Note that sepsis alone codes to 995.91, sepsis, in the ICD-9-CM Index to Diseases while sepsis with any linked acute organ dysfunction (not failure) codes to 995.92. This requirement to use 995.92 with sepsis and any linked acute organ dysfunction is further elaborated in the ICD-9-CM Official Guidelines that state:
"If a patient has sepsis and an acute organ dysfunction (emphasis added), but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign code 995.92, Severe sepsis. An acute organ dysfunction must be associated with clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider."
Once an acute organ dysfunction has been linked to sepsis, then the ICD-9-CM Table to Diseases continues to require the use of code 995.92, Severe Sepsis, and a code to specify the acute organ dysfunction (emphasis added). The list of organ dysfunctions and failures offered is not exhaustive, given the use of the word "such as" in the use additional code note.
[cid:image009.jpg@01D13BFC.E7460C60]
Correlation with Physician Literature
Physician literature corroborates ICD-9-CM in its definition of severe sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, defines "Severe Sepsis' as "sepsis-induced tissue hypoperfusion AND/OR organ dysfunction (emphasis added) documented to be due to infection. Please refer to Table 2 in this reference outlined below:
[cid:image010.jpg@01D13BFC.E7460C60]
Note that a number of these conditions are not in and of themselves organ failures. A patient can have prolonged hypotension but not be in septic shock if there is no evidence of tissue dysoxia on physical examination or manifested by an elevated lactate level. Bilirubin elevations (or jaundice) do not necessarily mean that acute liver failure is present. A platelet count of less than 100,000 does not necessarily mean that the bone marrow has failed or that the patient has disseminated intravascular coagulation. Hypoxemia alone is not acute hypoxemic respiratory failure unless other criteria are met.
As such, the coding rules allow for severe sepsis to be coded when the provider links an acute organ dysfunction to sepsis.
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:01 AM
To: Evans, Paul
Subject: [cdi_talk] ileus as organ dysfunction for severe sepsis
How do you feel about using ileus as an acute organ dysfunction to support the dx of severe sepsis? We have a CDI consultant who states that this is acceptable. The organ dysfunctions listed in the coding book do not include ileus however the list is prefaced with "use additional code to identify specific acute organ dysfunction such as..." This wording indicates to me that the list is not necessarily all-inclusive.
That said, my own research and reading have not shown a cause-effect relationship between sepsis and ileus and I cannot find an authoritative source that makes me want to jump on this bandwagon.
I would appreciate hearing others' insights and experience.
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
THIS MESSAGE IS CONFIDENTIAL. This e-mail message and any attachments are proprietary and confidential information intended only for the use of the recipient(s) named above. If you are not the intended recipient, you may not print,distribute, or copy this message or any attachments. If you have received this communication in error, please notify the sender by return e-mail and delete this message and any attachments from your computer. Any views or opinions expressed are solely those of the author and do not necessarily represent those of LRGHealthcare.
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CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:00 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks for sharing Paul
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:56 AM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks so much Paul. You confirmed my belief that I need provider documentation in order to support this connection. I have shared your thorough summary with my CDS's and coders.
Judy
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
[cid:image007.jpg@01D13BFC.E7460C60]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:34 PM
To: Riley, Judith
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Very complicated topic, and one that probably would take much communication to cover completely, but I have some notes on this topic.
I do agree that the 'organ dysfunctions' stated in the code book are NOT all-inclusive...this is only a partial listing. As one example, a type II AMI 2/2 to sepsis is not listed as an acute organ dysfunction associated with Severe Sepsis. Further, the coding conventions do not make a distinction between an organ "failure' and an organ 'dysfunction' and dysfunctions that do not rise to the level may be present in some patients w/ severe sepsis.
I made my notes on this topic prior to the conversion to I-10 guidelines.
"Surviving Sepsis" does include ileus as consequence of sepsis, as below from 2012 publication, p 6, Diagnostic Criteria.
[cid:image008.png@01D13BFC.E7460C60]
My current practice and philosophy, modify for implementation of I-10.
* Physician documentation is the basis for all coding. The recognition and management of Severe Sepsis is a difficult task that is the responsibility of physicians.
* Sepsis causing Multiple Organ Dysfunction Syndrome is coded as Severe Sepsis.
* Severe sepsis generally refers to sepsis with associated acute organ dysfunction (e.g., oliguria, hypoxemia, lactic acidosis, altered cerebral function, hypoperfusion, and hypotension).
* Severe sepsis requires additional code(s) for the associated acute organ dysfunction(s)-10. If a patient has sepsis with multiple organ dysfunctions, follow the instructions for coding severe sepsis.
* For patients with documentation of severe sepsis, the code for the systemic infection should be sequenced first, followed by code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction (Severe Sepsis).
* If it is unclear that the documented organ dysfunction or failure is due to sepsis, then a query should be rendered. With the exception of the term Septic Shock, the physician must clearly link the organ dysfunction to the sepsis.
* Associated organ dysfunctions or failures that are a manifestation of severe sepsis are coded to fully report the complexity and associated severity of illness and risk of mortality of the severe sepsis.
* If a documented acute organ dysfunction implies a more severe illness, if the clinical circumstances warrant it, a concurrent or retrospective communication should be initiated to determine what language best describes the patient's conditions so that appropriate ICD-9-CM codes may be assigned.
ICD-9-CM Official Coding Guidelines
AHA Coding Clinic
If a physician documents SIRS due to an infection and the criteria for sepsis is met, a query to determine if the patient has sepsis is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a patient meets the criteria for sepsis but the physician hasn't documented it, a query is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a physician documents sepsis but its clinical validity is questionable, a query is required
- Coding Clinic, 1st Quarter, 2012, page 19
"Severe sepsis is associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion/organ dysfunction may include, but is not limited to lactic acidosis, oliguria, and/or acute alteration in mental status."
- Coding Clinic(r) for ICD-9-CM, 2Q 2000, Volume 17, Number 2, Pages 3-7
ICD-9-CM Coding Rules applicable to Sepsis
The ICD-9-CM Official Guidelines and Coding Clinic for ICD-9-CM, official advice referable to ICD-9-CM, offer explicit advice regarding code assignment for patients documented to have sepsis and severe sepsis, assuming that the patient has these conditions and that these have been consistently and completely documented by a treating provider.
The ICD-9-CM Index to Diseases classifies sepsis and severe sepsis as follows:
................. Sepsis (generalized) 995.91
With (emphasis added)
abortion - see Abortion, by type, with sepsis
acute organ dysfunction (emphasis added) 995.92
ectopic pregnancy (see also categories 633.0-633.9) 639.0
molar pregnancy (see also categories 630-632) 639.0
multiple organ dysfunction (emphasis added) (MOD) 995.92
Note that sepsis alone codes to 995.91, sepsis, in the ICD-9-CM Index to Diseases while sepsis with any linked acute organ dysfunction (not failure) codes to 995.92. This requirement to use 995.92 with sepsis and any linked acute organ dysfunction is further elaborated in the ICD-9-CM Official Guidelines that state:
"If a patient has sepsis and an acute organ dysfunction (emphasis added), but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign code 995.92, Severe sepsis. An acute organ dysfunction must be associated with clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider."
Once an acute organ dysfunction has been linked to sepsis, then the ICD-9-CM Table to Diseases continues to require the use of code 995.92, Severe Sepsis, and a code to specify the acute organ dysfunction (emphasis added). The list of organ dysfunctions and failures offered is not exhaustive, given the use of the word "such as" in the use additional code note.
[cid:image009.jpg@01D13BFC.E7460C60]
Correlation with Physician Literature
Physician literature corroborates ICD-9-CM in its definition of severe sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, defines "Severe Sepsis' as "sepsis-induced tissue hypoperfusion AND/OR organ dysfunction (emphasis added) documented to be due to infection. Please refer to Table 2 in this reference outlined below:
[cid:image010.jpg@01D13BFC.E7460C60]
Note that a number of these conditions are not in and of themselves organ failures. A patient can have prolonged hypotension but not be in septic shock if there is no evidence of tissue dysoxia on physical examination or manifested by an elevated lactate level. Bilirubin elevations (or jaundice) do not necessarily mean that acute liver failure is present. A platelet count of less than 100,000 does not necessarily mean that the bone marrow has failed or that the patient has disseminated intravascular coagulation. Hypoxemia alone is not acute hypoxemic respiratory failure unless other criteria are met.
As such, the coding rules allow for severe sepsis to be coded when the provider links an acute organ dysfunction to sepsis.
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:01 AM
To: Evans, Paul
Subject: [cdi_talk] ileus as organ dysfunction for severe sepsis
How do you feel about using ileus as an acute organ dysfunction to support the dx of severe sepsis? We have a CDI consultant who states that this is acceptable. The organ dysfunctions listed in the coding book do not include ileus however the list is prefaced with "use additional code to identify specific acute organ dysfunction such as..." This wording indicates to me that the list is not necessarily all-inclusive.
That said, my own research and reading have not shown a cause-effect relationship between sepsis and ileus and I cannot find an authoritative source that makes me want to jump on this bandwagon.
I would appreciate hearing others' insights and experience.
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
THIS MESSAGE IS CONFIDENTIAL. This e-mail message and any attachments are proprietary and confidential information intended only for the use of the recipient(s) named above. If you are not the intended recipient, you may not print,distribute, or copy this message or any attachments. If you have received this communication in error, please notify the sender by return e-mail and delete this message and any attachments from your computer. Any views or opinions expressed are solely those of the author and do not necessarily represent those of LRGHealthcare.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: evanspx@sutterhealth.org
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12940161.4b24e9352adc7dfa247d8332246d4e2a@hcprotalk.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: jriley@lrgh.org
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: cynthia.hudson@christushealth.org
If you would like to be removed from CDI Talk, please send a blank email to
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CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
Comments
When it comes to cancer, I try to think about the cancer as the chronic condition and the 'acute change' is what is the reason for admission and Pdx. The patient has had cancer for some time. But what is the acute issue that brings them to the hospital?
Anemia is the exception to this, of course....
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:36 PM
To: Kathryn Good
Subject: [cdi_talk] Question about Neoplasms
Patient admitted for Peritoneal abscess due to malignant neoplasm of peritoneum. What is the appropriate sequencing? I am trying to find the correct coding clinic.
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:00 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks for sharing Paul
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:56 AM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks so much Paul. You confirmed my belief that I need provider documentation in order to support this connection. I have shared your thorough summary with my CDS's and coders.
Judy
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
[cid:image002.jpg@01D13BFA.755A9AF0]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:34 PM
To: Riley, Judith
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Very complicated topic, and one that probably would take much communication to cover completely, but I have some notes on this topic.
I do agree that the 'organ dysfunctions' stated in the code book are NOT all-inclusive...this is only a partial listing. As one example, a type II AMI 2/2 to sepsis is not listed as an acute organ dysfunction associated with Severe Sepsis. Further, the coding conventions do not make a distinction between an organ "failure' and an organ 'dysfunction' and dysfunctions that do not rise to the level may be present in some patients w/ severe sepsis.
I made my notes on this topic prior to the conversion to I-10 guidelines.
"Surviving Sepsis" does include ileus as consequence of sepsis, as below from 2012 publication, p 6, Diagnostic Criteria.
[cid:image003.png@01D13BFA.755A9AF0]
My current practice and philosophy, modify for implementation of I-10.
* Physician documentation is the basis for all coding. The recognition and management of Severe Sepsis is a difficult task that is the responsibility of physicians.
* Sepsis causing Multiple Organ Dysfunction Syndrome is coded as Severe Sepsis.
* Severe sepsis generally refers to sepsis with associated acute organ dysfunction (e.g., oliguria, hypoxemia, lactic acidosis, altered cerebral function, hypoperfusion, and hypotension).
* Severe sepsis requires additional code(s) for the associated acute organ dysfunction(s)-10. If a patient has sepsis with multiple organ dysfunctions, follow the instructions for coding severe sepsis.
* For patients with documentation of severe sepsis, the code for the systemic infection should be sequenced first, followed by code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction (Severe Sepsis).
* If it is unclear that the documented organ dysfunction or failure is due to sepsis, then a query should be rendered. With the exception of the term Septic Shock, the physician must clearly link the organ dysfunction to the sepsis.
* Associated organ dysfunctions or failures that are a manifestation of severe sepsis are coded to fully report the complexity and associated severity of illness and risk of mortality of the severe sepsis.
* If a documented acute organ dysfunction implies a more severe illness, if the clinical circumstances warrant it, a concurrent or retrospective communication should be initiated to determine what language best describes the patient's conditions so that appropriate ICD-9-CM codes may be assigned.
ICD-9-CM Official Coding Guidelines
AHA Coding Clinic
If a physician documents SIRS due to an infection and the criteria for sepsis is met, a query to determine if the patient has sepsis is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a patient meets the criteria for sepsis but the physician hasn't documented it, a query is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a physician documents sepsis but its clinical validity is questionable, a query is required
- Coding Clinic, 1st Quarter, 2012, page 19
"Severe sepsis is associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion/organ dysfunction may include, but is not limited to lactic acidosis, oliguria, and/or acute alteration in mental status."
- Coding Clinic(r) for ICD-9-CM, 2Q 2000, Volume 17, Number 2, Pages 3-7
ICD-9-CM Coding Rules applicable to Sepsis
The ICD-9-CM Official Guidelines and Coding Clinic for ICD-9-CM, official advice referable to ICD-9-CM, offer explicit advice regarding code assignment for patients documented to have sepsis and severe sepsis, assuming that the patient has these conditions and that these have been consistently and completely documented by a treating provider.
The ICD-9-CM Index to Diseases classifies sepsis and severe sepsis as follows:
................. Sepsis (generalized) 995.91
With (emphasis added)
abortion - see Abortion, by type, with sepsis
acute organ dysfunction (emphasis added) 995.92
ectopic pregnancy (see also categories 633.0-633.9) 639.0
molar pregnancy (see also categories 630-632) 639.0
multiple organ dysfunction (emphasis added) (MOD) 995.92
Note that sepsis alone codes to 995.91, sepsis, in the ICD-9-CM Index to Diseases while sepsis with any linked acute organ dysfunction (not failure) codes to 995.92. This requirement to use 995.92 with sepsis and any linked acute organ dysfunction is further elaborated in the ICD-9-CM Official Guidelines that state:
"If a patient has sepsis and an acute organ dysfunction (emphasis added), but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign code 995.92, Severe sepsis. An acute organ dysfunction must be associated with clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider."
Once an acute organ dysfunction has been linked to sepsis, then the ICD-9-CM Table to Diseases continues to require the use of code 995.92, Severe Sepsis, and a code to specify the acute organ dysfunction (emphasis added). The list of organ dysfunctions and failures offered is not exhaustive, given the use of the word "such as" in the use additional code note.
[cid:image004.jpg@01D13BFA.755A9AF0]
Correlation with Physician Literature
Physician literature corroborates ICD-9-CM in its definition of severe sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, defines "Severe Sepsis' as "sepsis-induced tissue hypoperfusion AND/OR organ dysfunction (emphasis added) documented to be due to infection. Please refer to Table 2 in this reference outlined below:
[cid:image005.jpg@01D13BFA.755A9AF0]
Note that a number of these conditions are not in and of themselves organ failures. A patient can have prolonged hypotension but not be in septic shock if there is no evidence of tissue dysoxia on physical examination or manifested by an elevated lactate level. Bilirubin elevations (or jaundice) do not necessarily mean that acute liver failure is present. A platelet count of less than 100,000 does not necessarily mean that the bone marrow has failed or that the patient has disseminated intravascular coagulation. Hypoxemia alone is not acute hypoxemic respiratory failure unless other criteria are met.
As such, the coding rules allow for severe sepsis to be coded when the provider links an acute organ dysfunction to sepsis.
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:01 AM
To: Evans, Paul
Subject: [cdi_talk] ileus as organ dysfunction for severe sepsis
How do you feel about using ileus as an acute organ dysfunction to support the dx of severe sepsis? We have a CDI consultant who states that this is acceptable. The organ dysfunctions listed in the coding book do not include ileus however the list is prefaced with "use additional code to identify specific acute organ dysfunction such as..." This wording indicates to me that the list is not necessarily all-inclusive.
That said, my own research and reading have not shown a cause-effect relationship between sepsis and ileus and I cannot find an authoritative source that makes me want to jump on this bandwagon.
I would appreciate hearing others' insights and experience.
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
THIS MESSAGE IS CONFIDENTIAL. This e-mail message and any attachments are proprietary and confidential information intended only for the use of the recipient(s) named above. If you are not the intended recipient, you may not print,distribute, or copy this message or any attachments. If you have received this communication in error, please notify the sender by return e-mail and delete this message and any attachments from your computer. Any views or opinions expressed are solely those of the author and do not necessarily represent those of LRGHealthcare.
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Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 3:21 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] Question about Neoplasms
I believe the abscess would be Pdx. When admission is for a complication associated with the neoplasm and treatment is directed only at this complication, the complication is sequenced first. This Is from the Coding guidelines.
When it comes to cancer, I try to think about the cancer as the chronic condition and the 'acute change' is what is the reason for admission and Pdx. The patient has had cancer for some time. But what is the acute issue that brings them to the hospital?
Anemia is the exception to this, of course....
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:36 PM
To: Kathryn Good
Subject: [cdi_talk] Question about Neoplasms
Patient admitted for Peritoneal abscess due to malignant neoplasm of peritoneum. What is the appropriate sequencing? I am trying to find the correct coding clinic.
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:00 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks for sharing Paul
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:56 AM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks so much Paul. You confirmed my belief that I need provider documentation in order to support this connection. I have shared your thorough summary with my CDS's and coders.
Judy
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
[cid:image002.jpg@01D13C05.005DB7E0]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:34 PM
To: Riley, Judith
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Very complicated topic, and one that probably would take much communication to cover completely, but I have some notes on this topic.
I do agree that the 'organ dysfunctions' stated in the code book are NOT all-inclusive...this is only a partial listing. As one example, a type II AMI 2/2 to sepsis is not listed as an acute organ dysfunction associated with Severe Sepsis. Further, the coding conventions do not make a distinction between an organ "failure' and an organ 'dysfunction' and dysfunctions that do not rise to the level may be present in some patients w/ severe sepsis.
I made my notes on this topic prior to the conversion to I-10 guidelines.
"Surviving Sepsis" does include ileus as consequence of sepsis, as below from 2012 publication, p 6, Diagnostic Criteria.
[cid:image003.png@01D13C05.005DB7E0]
My current practice and philosophy, modify for implementation of I-10.
* Physician documentation is the basis for all coding. The recognition and management of Severe Sepsis is a difficult task that is the responsibility of physicians.
* Sepsis causing Multiple Organ Dysfunction Syndrome is coded as Severe Sepsis.
* Severe sepsis generally refers to sepsis with associated acute organ dysfunction (e.g., oliguria, hypoxemia, lactic acidosis, altered cerebral function, hypoperfusion, and hypotension).
* Severe sepsis requires additional code(s) for the associated acute organ dysfunction(s)-10. If a patient has sepsis with multiple organ dysfunctions, follow the instructions for coding severe sepsis.
* For patients with documentation of severe sepsis, the code for the systemic infection should be sequenced first, followed by code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction (Severe Sepsis).
* If it is unclear that the documented organ dysfunction or failure is due to sepsis, then a query should be rendered. With the exception of the term Septic Shock, the physician must clearly link the organ dysfunction to the sepsis.
* Associated organ dysfunctions or failures that are a manifestation of severe sepsis are coded to fully report the complexity and associated severity of illness and risk of mortality of the severe sepsis.
* If a documented acute organ dysfunction implies a more severe illness, if the clinical circumstances warrant it, a concurrent or retrospective communication should be initiated to determine what language best describes the patient's conditions so that appropriate ICD-9-CM codes may be assigned.
ICD-9-CM Official Coding Guidelines
AHA Coding Clinic
If a physician documents SIRS due to an infection and the criteria for sepsis is met, a query to determine if the patient has sepsis is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a patient meets the criteria for sepsis but the physician hasn't documented it, a query is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a physician documents sepsis but its clinical validity is questionable, a query is required
- Coding Clinic, 1st Quarter, 2012, page 19
"Severe sepsis is associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion/organ dysfunction may include, but is not limited to lactic acidosis, oliguria, and/or acute alteration in mental status."
- Coding Clinic(r) for ICD-9-CM, 2Q 2000, Volume 17, Number 2, Pages 3-7
ICD-9-CM Coding Rules applicable to Sepsis
The ICD-9-CM Official Guidelines and Coding Clinic for ICD-9-CM, official advice referable to ICD-9-CM, offer explicit advice regarding code assignment for patients documented to have sepsis and severe sepsis, assuming that the patient has these conditions and that these have been consistently and completely documented by a treating provider.
The ICD-9-CM Index to Diseases classifies sepsis and severe sepsis as follows:
................. Sepsis (generalized) 995.91
With (emphasis added)
abortion - see Abortion, by type, with sepsis
acute organ dysfunction (emphasis added) 995.92
ectopic pregnancy (see also categories 633.0-633.9) 639.0
molar pregnancy (see also categories 630-632) 639.0
multiple organ dysfunction (emphasis added) (MOD) 995.92
Note that sepsis alone codes to 995.91, sepsis, in the ICD-9-CM Index to Diseases while sepsis with any linked acute organ dysfunction (not failure) codes to 995.92. This requirement to use 995.92 with sepsis and any linked acute organ dysfunction is further elaborated in the ICD-9-CM Official Guidelines that state:
"If a patient has sepsis and an acute organ dysfunction (emphasis added), but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign code 995.92, Severe sepsis. An acute organ dysfunction must be associated with clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider."
Once an acute organ dysfunction has been linked to sepsis, then the ICD-9-CM Table to Diseases continues to require the use of code 995.92, Severe Sepsis, and a code to specify the acute organ dysfunction (emphasis added). The list of organ dysfunctions and failures offered is not exhaustive, given the use of the word "such as" in the use additional code note.
[cid:image004.jpg@01D13C05.005DB7E0]
Correlation with Physician Literature
Physician literature corroborates ICD-9-CM in its definition of severe sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, defines "Severe Sepsis' as "sepsis-induced tissue hypoperfusion AND/OR organ dysfunction (emphasis added) documented to be due to infection. Please refer to Table 2 in this reference outlined below:
[cid:image005.jpg@01D13C05.005DB7E0]
Note that a number of these conditions are not in and of themselves organ failures. A patient can have prolonged hypotension but not be in septic shock if there is no evidence of tissue dysoxia on physical examination or manifested by an elevated lactate level. Bilirubin elevations (or jaundice) do not necessarily mean that acute liver failure is present. A platelet count of less than 100,000 does not necessarily mean that the bone marrow has failed or that the patient has disseminated intravascular coagulation. Hypoxemia alone is not acute hypoxemic respiratory failure unless other criteria are met.
As such, the coding rules allow for severe sepsis to be coded when the provider links an acute organ dysfunction to sepsis.
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:01 AM
To: Evans, Paul
Subject: [cdi_talk] ileus as organ dysfunction for severe sepsis
How do you feel about using ileus as an acute organ dysfunction to support the dx of severe sepsis? We have a CDI consultant who states that this is acceptable. The organ dysfunctions listed in the coding book do not include ileus however the list is prefaced with "use additional code to identify specific acute organ dysfunction such as..." This wording indicates to me that the list is not necessarily all-inclusive.
That said, my own research and reading have not shown a cause-effect relationship between sepsis and ileus and I cannot find an authoritative source that makes me want to jump on this bandwagon.
I would appreciate hearing others' insights and experience.
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
THIS MESSAGE IS CONFIDENTIAL. This e-mail message and any attachments are proprietary and confidential information intended only for the use of the recipient(s) named above. If you are not the intended recipient, you may not print,distribute, or copy this message or any attachments. If you have received this communication in error, please notify the sender by return e-mail and delete this message and any attachments from your computer. Any views or opinions expressed are solely those of the author and do not necessarily represent those of LRGHealthcare.
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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
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If the anemia is an adverse effect of treatment of the neoplasm (chemo/radiation), then the anemia can be sequenced first. This is consistent with ICD-9.
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 2:34 PM
To: Kathryn Good
Subject: RE:[cdi_talk] Question about Neoplasms
Thanks Katy. I did see a coding clinic that said anemia could be principal if it was the sole reason for admit and was the principal issue being treated. Is this correct?
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 3:21 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] Question about Neoplasms
I believe the abscess would be Pdx. When admission is for a complication associated with the neoplasm and treatment is directed only at this complication, the complication is sequenced first. This Is from the Coding guidelines.
When it comes to cancer, I try to think about the cancer as the chronic condition and the 'acute change' is what is the reason for admission and Pdx. The patient has had cancer for some time. But what is the acute issue that brings them to the hospital?
Anemia is the exception to this, of course....
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:36 PM
To: Kathryn Good
Subject: [cdi_talk] Question about Neoplasms
Patient admitted for Peritoneal abscess due to malignant neoplasm of peritoneum. What is the appropriate sequencing? I am trying to find the correct coding clinic.
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:00 PM
To: Hudson, Cynthia
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks for sharing Paul
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:56 AM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Thanks so much Paul. You confirmed my belief that I need provider documentation in order to support this connection. I have shared your thorough summary with my CDS's and coders.
Judy
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
[cid:image002.jpg@01D13BFD.97B0B500]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 1:34 PM
To: Riley, Judith
Subject: RE:[cdi_talk] ileus as organ dysfunction for severe sepsis
Very complicated topic, and one that probably would take much communication to cover completely, but I have some notes on this topic.
I do agree that the 'organ dysfunctions' stated in the code book are NOT all-inclusive...this is only a partial listing. As one example, a type II AMI 2/2 to sepsis is not listed as an acute organ dysfunction associated with Severe Sepsis. Further, the coding conventions do not make a distinction between an organ "failure' and an organ 'dysfunction' and dysfunctions that do not rise to the level may be present in some patients w/ severe sepsis.
I made my notes on this topic prior to the conversion to I-10 guidelines.
"Surviving Sepsis" does include ileus as consequence of sepsis, as below from 2012 publication, p 6, Diagnostic Criteria.
[cid:image003.png@01D13BFD.97B0B500]
My current practice and philosophy, modify for implementation of I-10.
* Physician documentation is the basis for all coding. The recognition and management of Severe Sepsis is a difficult task that is the responsibility of physicians.
* Sepsis causing Multiple Organ Dysfunction Syndrome is coded as Severe Sepsis.
* Severe sepsis generally refers to sepsis with associated acute organ dysfunction (e.g., oliguria, hypoxemia, lactic acidosis, altered cerebral function, hypoperfusion, and hypotension).
* Severe sepsis requires additional code(s) for the associated acute organ dysfunction(s)-10. If a patient has sepsis with multiple organ dysfunctions, follow the instructions for coding severe sepsis.
* For patients with documentation of severe sepsis, the code for the systemic infection should be sequenced first, followed by code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction (Severe Sepsis).
* If it is unclear that the documented organ dysfunction or failure is due to sepsis, then a query should be rendered. With the exception of the term Septic Shock, the physician must clearly link the organ dysfunction to the sepsis.
* Associated organ dysfunctions or failures that are a manifestation of severe sepsis are coded to fully report the complexity and associated severity of illness and risk of mortality of the severe sepsis.
* If a documented acute organ dysfunction implies a more severe illness, if the clinical circumstances warrant it, a concurrent or retrospective communication should be initiated to determine what language best describes the patient's conditions so that appropriate ICD-9-CM codes may be assigned.
ICD-9-CM Official Coding Guidelines
AHA Coding Clinic
If a physician documents SIRS due to an infection and the criteria for sepsis is met, a query to determine if the patient has sepsis is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a patient meets the criteria for sepsis but the physician hasn't documented it, a query is required
- Coding Clinic, 3rd Quarter, 2014, page 4
If a physician documents sepsis but its clinical validity is questionable, a query is required
- Coding Clinic, 1st Quarter, 2012, page 19
"Severe sepsis is associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion/organ dysfunction may include, but is not limited to lactic acidosis, oliguria, and/or acute alteration in mental status."
- Coding Clinic(r) for ICD-9-CM, 2Q 2000, Volume 17, Number 2, Pages 3-7
ICD-9-CM Coding Rules applicable to Sepsis
The ICD-9-CM Official Guidelines and Coding Clinic for ICD-9-CM, official advice referable to ICD-9-CM, offer explicit advice regarding code assignment for patients documented to have sepsis and severe sepsis, assuming that the patient has these conditions and that these have been consistently and completely documented by a treating provider.
The ICD-9-CM Index to Diseases classifies sepsis and severe sepsis as follows:
................. Sepsis (generalized) 995.91
With (emphasis added)
abortion - see Abortion, by type, with sepsis
acute organ dysfunction (emphasis added) 995.92
ectopic pregnancy (see also categories 633.0-633.9) 639.0
molar pregnancy (see also categories 630-632) 639.0
multiple organ dysfunction (emphasis added) (MOD) 995.92
Note that sepsis alone codes to 995.91, sepsis, in the ICD-9-CM Index to Diseases while sepsis with any linked acute organ dysfunction (not failure) codes to 995.92. This requirement to use 995.92 with sepsis and any linked acute organ dysfunction is further elaborated in the ICD-9-CM Official Guidelines that state:
"If a patient has sepsis and an acute organ dysfunction (emphasis added), but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign code 995.92, Severe sepsis. An acute organ dysfunction must be associated with clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider."
Once an acute organ dysfunction has been linked to sepsis, then the ICD-9-CM Table to Diseases continues to require the use of code 995.92, Severe Sepsis, and a code to specify the acute organ dysfunction (emphasis added). The list of organ dysfunctions and failures offered is not exhaustive, given the use of the word "such as" in the use additional code note.
[cid:image004.jpg@01D13BFD.97B0B500]
Correlation with Physician Literature
Physician literature corroborates ICD-9-CM in its definition of severe sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, defines "Severe Sepsis' as "sepsis-induced tissue hypoperfusion AND/OR organ dysfunction (emphasis added) documented to be due to infection. Please refer to Table 2 in this reference outlined below:
[cid:image005.jpg@01D13BFD.97B0B500]
Note that a number of these conditions are not in and of themselves organ failures. A patient can have prolonged hypotension but not be in septic shock if there is no evidence of tissue dysoxia on physical examination or manifested by an elevated lactate level. Bilirubin elevations (or jaundice) do not necessarily mean that acute liver failure is present. A platelet count of less than 100,000 does not necessarily mean that the bone marrow has failed or that the patient has disseminated intravascular coagulation. Hypoxemia alone is not acute hypoxemic respiratory failure unless other criteria are met.
As such, the coding rules allow for severe sepsis to be coded when the provider links an acute organ dysfunction to sepsis.
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, December 21, 2015 10:01 AM
To: Evans, Paul
Subject: [cdi_talk] ileus as organ dysfunction for severe sepsis
How do you feel about using ileus as an acute organ dysfunction to support the dx of severe sepsis? We have a CDI consultant who states that this is acceptable. The organ dysfunctions listed in the coding book do not include ileus however the list is prefaced with "use additional code to identify specific acute organ dysfunction such as..." This wording indicates to me that the list is not necessarily all-inclusive.
That said, my own research and reading have not shown a cause-effect relationship between sepsis and ileus and I cannot find an authoritative source that makes me want to jump on this bandwagon.
I would appreciate hearing others' insights and experience.
Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org
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