septic shock

Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
Thanks,
Kerry

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

Celebrating 100 Years of Care in our community
#NWH100YearsOfCare





________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.

Comments

  • Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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

  • Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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

  • Re: Shock (and Lactate Levels)

    [cid:image002.png@01D147CD.0DAF38F0]


    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

  • In particular, Statements 9 & 12 speak to B/P and Lactate visa vie 'shock'........much more on line if you care to download this document.



    [cid:image002.png@01D147CD.B31F0F40]

    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:image003.jpg@01D147CD.B31F0F40]

  • edited March 2016
    And I think what Paul provided supports the pediatric definition of shock, which is often identifiable before the blood pressure actually drops but signs and symptoms (and labs) supporting tissue dysoxia are already available.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • We also have a query that would enable physicians to choose severe sepsis and do not query for septic shock unless otherwise indicated with hypotension and pressors, etc.

    Lona McNamara, RN, BSN, CCM,
    Clinical Documentation
    lmcnamara@cortlandregional.org

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:00 PM
    To: McNamara,Lona A
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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

  • Paul
    it looks like you are referring to a document but I can not see this. Can you share?
    Sara Filas
    Sara.filas@aspirus.org
  • edited March 2016
    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013





  • Hello, Everyone



    Here is a link to an excellent article for Shock (lactate acidosis, and much more) w/ consensus opinions, definitions, Best Practice, so forth.





    [cid:image001.png@01D1485E.20AE6200]



    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



  • edited March 2016
    Hi Paul-
    The link is not coming through-can you maybe share the name of the article/resource and I can search it that way?
    Thanks again,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

  • Thanks Paul. Very helpful.

    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: Wednesday, January 06, 2016 10:46 AM
    To: Hudson, Cynthia
    Subject: RE: RE:[cdi_talk] septic shock

    Hi, Kerry


    I am attaching a PDF of the actual document.

    Paul

    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: Wednesday, January 06, 2016 8:44 AM
    To: Evans, Paul
    Subject: RE: RE:[cdi_talk] septic shock

    Hi Paul-
    The link is not coming through-can you maybe share the name of the article/resource and I can search it that way?
    Thanks again,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D14863.A6B336A0]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 11:42 AM
    To: Seekircher, Kerry
    Subject: RE: RE:[cdi_talk] septic shock


    Hello, Everyone



    Here is a link to an excellent article for Shock (lactate acidosis, and much more) w/ consensus opinions, definitions, Best Practice, so forth.





    [cid:image007.png@01D1486F.DF1E4E10]



    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







    -----Original Message-----
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 6:22 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] septic shock



    Paul

    it looks like you are referring to a document but I can not see this. Can you share?

    Sara Filas

    Sara.filas@aspirus.org

    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923





    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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

    leave-cdi_talk-20300583.8b3d4c3668f0a393ca5965a83240279a@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923


    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.
  • Hi, Kerry

    Always good for all of us to review and study as many valid definitions as feasible. Of course, one ongoing issue or problem with CMS core measures is that these measures are abstracted and reported by RNs, independent of the documentation of the Medical Staff. Whereas, the coded data, of course, is 100% dependent upon very explicit documentation - i.e. "Paul presents with acute kidney injury due to Sepsis is coded as Severe Sepsis"...whereas the statement...."Paul has: 1. Sepsis 2. Acute Kidney Injury... may NOT be coded as Severe Sepsis lacking explicit documentation of cause & effect.

    I do worry about the dissonance between data used for quality purposes and billing and administrative data as I think about this particular issue. It is a daunting challenge for all.

    [cid:image003.png@01D1485F.9201CEA0]

    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@01D1485F.4B7002E0]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:12 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D1485F.4B7002E0]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:14 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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@01D1485F.4B7002E0]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 3:00 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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: Tuesday, January 05, 2016 3:54 PM
    To: Kathryn Good
    Subject: [cdi_talk] septic shock

    Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
    Thanks,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    Celebrating 100 Years of Care in our community
    #NWH100YearsOfCare





    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
  • Kerry: Portion of CMS Abstraction Guidelines w/ reference to Lactate levels







    Collected For: CMS: SEP-1

    Definition: Documentation of the presence of septic shock.

    Suggested Data Collection Question: Is there documentation of the presence of septic shock?

    Format:

    Length: 1

    Type: Alphanumeric

    Occurs: 1

    Allowable Values:

    1 (Yes) There is documentation of Septic Shock

    2 (No) There is no documentation of Septic Shock, or unable to determine



    Notes for Abstraction:

    * The criteria for determining that Septic Shock is present are as follows:

    a. There must be documentation of severe sepsis present.



    AND

    b. Hypotension persists in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration, evidenced by

    * systolic blood pressure (SBP) < 90, or

    * mean arterial pressure < 65 or

    * a decrease in systolic blood pressure by > 40 mmHg from the last previously recorded SBP considered normal for that specific patient



    OR

    Tissue hypoperfusion is present evidenced by

    * Initial Lactate level is >= 4 mmol/L



    Examples:

    Example 1:

    Patient 1 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Initial lactate level was 4.4. Choose Value "1" for Septic Shock Present.

    Example 2:

    Patient 2 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Blood pressure was stable at 130/76 and initial lactate level was 1.8. Choose Value "2" for this patient.

    Example 3:


    Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-15 (4Q15) through 06-30-16 (2Q16)

    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@01D14861.C6C51F50]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:12 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D14861.C6C51F50]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:14 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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@01D14861.C6C51F50]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 3:00 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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: Tuesday, January 05, 2016 3:54 PM
    To: Kathryn Good
    Subject: [cdi_talk] septic shock

    Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
    Thanks,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    Celebrating 100 Years of Care in our community
    #NWH100YearsOfCare





    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
  • So interesting!

    Our quality team is who drove the institutional definitions at our facility because of the new core measure. They developed a Care Process Model to manage our sepsis patients and within that model defined Sepsis/Severe Sepsis/Septic shock. They did not include Lactate level in their definition of septic shock.

    I am going to ask them about it today but currently we are using the institutional definitions they have established to drive our queries.

    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: Wednesday, January 06, 2016 10:08 AM
    To: Kathryn Good
    Subject: RE: [cdi_talk] septic shock


    Kerry: Portion of CMS Abstraction Guidelines w/ reference to Lactate levels







    Collected For: CMS: SEP-1

    Definition: Documentation of the presence of septic shock.

    Suggested Data Collection Question: Is there documentation of the presence of septic shock?

    Format:

    Length: 1

    Type: Alphanumeric

    Occurs: 1

    Allowable Values:

    1 (Yes) There is documentation of Septic Shock

    2 (No) There is no documentation of Septic Shock, or unable to determine



    Notes for Abstraction:

    * The criteria for determining that Septic Shock is present are as follows:

    a. There must be documentation of severe sepsis present.



    AND

    b. Hypotension persists in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration, evidenced by

    * systolic blood pressure (SBP) < 90, or

    * mean arterial pressure < 65 or

    * a decrease in systolic blood pressure by > 40 mmHg from the last previously recorded SBP considered normal for that specific patient



    OR

    Tissue hypoperfusion is present evidenced by

    * Initial Lactate level is >= 4 mmol/L



    Examples:

    Example 1:

    Patient 1 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Initial lactate level was 4.4. Choose Value "1" for Septic Shock Present.

    Example 2:

    Patient 2 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Blood pressure was stable at 130/76 and initial lactate level was 1.8. Choose Value "2" for this patient.

    Example 3:


    Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-15 (4Q15) through 06-30-16 (2Q16)

    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: Wednesday, January 06, 2016 8:12 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D14863.A6B336A0]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:14 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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: Tuesday, January 05, 2016 3:00 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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: Tuesday, January 05, 2016 3:54 PM
    To: Kathryn Good
    Subject: [cdi_talk] septic shock

    Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
    Thanks,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    Celebrating 100 Years of Care in our community
    #NWH100YearsOfCare





    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam
  • We are fortunate in that our CDI Team works for the VP of quality, and he is an ICU MD, as well as one of the authors of the 2012 Surviving Sepsis Publication.

    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@01D14864.577C2BE0]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 9:23 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    So interesting!

    Our quality team is who drove the institutional definitions at our facility because of the new core measure. They developed a Care Process Model to manage our sepsis patients and within that model defined Sepsis/Severe Sepsis/Septic shock. They did not include Lactate level in their definition of septic shock.

    I am going to ask them about it today but currently we are using the institutional definitions they have established to drive our queries.

    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: Wednesday, January 06, 2016 10:08 AM
    To: Kathryn Good
    Subject: RE: [cdi_talk] septic shock


    Kerry: Portion of CMS Abstraction Guidelines w/ reference to Lactate levels







    Collected For: CMS: SEP-1

    Definition: Documentation of the presence of septic shock.

    Suggested Data Collection Question: Is there documentation of the presence of septic shock?

    Format:

    Length: 1

    Type: Alphanumeric

    Occurs: 1

    Allowable Values:

    1 (Yes) There is documentation of Septic Shock

    2 (No) There is no documentation of Septic Shock, or unable to determine



    Notes for Abstraction:

    * The criteria for determining that Septic Shock is present are as follows:

    a. There must be documentation of severe sepsis present.



    AND

    b. Hypotension persists in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration, evidenced by

    * systolic blood pressure (SBP) < 90, or

    * mean arterial pressure < 65 or

    * a decrease in systolic blood pressure by > 40 mmHg from the last previously recorded SBP considered normal for that specific patient



    OR

    Tissue hypoperfusion is present evidenced by

    * Initial Lactate level is >= 4 mmol/L



    Examples:

    Example 1:

    Patient 1 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Initial lactate level was 4.4. Choose Value "1" for Septic Shock Present.

    Example 2:

    Patient 2 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Blood pressure was stable at 130/76 and initial lactate level was 1.8. Choose Value "2" for this patient.

    Example 3:


    Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-15 (4Q15) through 06-30-16 (2Q16)

    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@01D14864.577C2BE0]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:12 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D14864.577C2BE0]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:14 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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@01D14864.577C2BE0]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 3:00 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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: Tuesday, January 05, 2016 3:54 PM
    To: Kathryn Good
    Subject: [cdi_talk] septic shock

    Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
    Thanks,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    Celebrating 100 Years of Care in our community
    #NWH100YearsOfCare





    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
  • I was also instructed that a lactic acid >1 (along with sirs criteria/infectious source) can be indicative of sepsis and a lactic acid >2 is consistent with severe sepsis.
    The CMS abstraction guidelines is what I saw yesterday and I'm waiting on the full copy from quality-thank you for sharing in the meantime.

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D1487E.8EF11B20]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 12:27 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    We are fortunate in that our CDI Team works for the VP of quality, and he is an ICU MD, as well as one of the authors of the 2012 Surviving Sepsis Publication.

    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:image003.jpg@01D1487E.8EF11B20]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 9:23 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    So interesting!

    Our quality team is who drove the institutional definitions at our facility because of the new core measure. They developed a Care Process Model to manage our sepsis patients and within that model defined Sepsis/Severe Sepsis/Septic shock. They did not include Lactate level in their definition of septic shock.

    I am going to ask them about it today but currently we are using the institutional definitions they have established to drive our queries.

    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: Wednesday, January 06, 2016 10:08 AM
    To: Kathryn Good
    Subject: RE: [cdi_talk] septic shock


    Kerry: Portion of CMS Abstraction Guidelines w/ reference to Lactate levels







    Collected For: CMS: SEP-1

    Definition: Documentation of the presence of septic shock.

    Suggested Data Collection Question: Is there documentation of the presence of septic shock?

    Format:

    Length: 1

    Type: Alphanumeric

    Occurs: 1

    Allowable Values:

    1 (Yes) There is documentation of Septic Shock

    2 (No) There is no documentation of Septic Shock, or unable to determine



    Notes for Abstraction:

    * The criteria for determining that Septic Shock is present are as follows:

    a. There must be documentation of severe sepsis present.



    AND

    b. Hypotension persists in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration, evidenced by

    * systolic blood pressure (SBP) < 90, or

    * mean arterial pressure < 65 or

    * a decrease in systolic blood pressure by > 40 mmHg from the last previously recorded SBP considered normal for that specific patient



    OR

    Tissue hypoperfusion is present evidenced by

    * Initial Lactate level is >= 4 mmol/L



    Examples:

    Example 1:

    Patient 1 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Initial lactate level was 4.4. Choose Value "1" for Septic Shock Present.

    Example 2:

    Patient 2 met all criteria for Severe Sepsis (answered Value "1" to Data Element Severe Sepsis Present). Blood pressure was stable at 130/76 and initial lactate level was 1.8. Choose Value "2" for this patient.

    Example 3:


    Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-15 (4Q15) through 06-30-16 (2Q16)

    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:image003.jpg@01D1487E.8EF11B20]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:12 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock

    Hi Paul-
    This is consistent with what I've been hearing.
    Don't quote me on this, but at a sepsis workgroup meeting yesterday, I got the sense that this was clearly indicated in the CMS guidelines for the sepsis core measure.
    I'm going to get some info back from our quality dept today, and if it something that I can share, I will.
    Thank you all for your input.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    [cid:image002.png@01D1487E.8EF11B20]


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 6:14 PM
    To: Seekircher, Kerry
    Subject: RE: [cdi_talk] septic shock

    Hello,

    We do query for septic shock if the lactate level is greater than 4...per our ICU clinical staff and formal advisors, there is strong clinical support that this level represents a form of shock in septic patients.

    PE

    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:image003.jpg@01D1487E.8EF11B20]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, January 05, 2016 3:00 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] septic shock


    Hi Kerry,



    No. We recently created institutional definitions for SIRS/SEPSIS/Severe sepsis/Septic shock



    Septic Shock:

    Sepsis-induced hypotension persisting despite adequate fluid resuscitation (at least 30mL/kg except where high volume resuscitation is contraindicated) defined as severe sepsis associated with refractory hypotension and poor response to crystalloids, requiring vasopressor support.


    Elevated lactate >4 certainly supports (is consistent with) a diagnosis of severe sepsis but (in my assessment) should not be used independently as an indication to query.

    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: Tuesday, January 05, 2016 3:54 PM
    To: Kathryn Good
    Subject: [cdi_talk] septic shock

    Just curious-in the absence of hypotension, do you query for septic shock when the lactic acid is >4 (and the pt has an infection and other sirs criteria indicative of severe sepsis)?
    Thanks,
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

    Celebrating 100 Years of Care in our community
    #NWH100YearsOfCare





    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.



    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kathryn.good@nahealth.com

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923




    This message has been scanned and no issues were detected.

    Do not trust links or attachments and do not divulge sensitive information upon email request.

    Click here to report this email as spam






    ---

    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

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



    ---

    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: kseekircher@nwhc.net

    If you would like to be removed from CDI Talk, please send a blank email to

    leave-cdi_talk-20097959.d65e69fc5d7027e8a40023ced48ccf9e@hcprotalk.com

    ---

    Copyright 2013

    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

    ________________________________
    Note:
    This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.

    Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
  • Great stuff - and the CMS Guidelines for audits are very helpful - for adults. As we agreed, the criteria for Pediatrics would be most helpful as Kids are Not Small Adults.

    Septic shock: Rapid recognition and initial resuscitation in children
    Authors: Scott L Weiss, MD; Wendy J Pomerantz, MD, MS
    Section Editors: Adrienne G Randolph, MD, MSc; Susan B Torrey, MD; Sheldon L Kaplan, MD

    DEFINITION - Septic shock refers to sepsis with cardiovascular dysfunction (ie, hypotension, reliance on vasoactive drug administration to maintain a normal blood pressure, or two of the following: prolonged capillary refill, oliguria, metabolic acidosis, or elevated arterial lactate) that persists despite the administration of
  • edited March 2016
    Thanks all-the feedback and resources have been helpful.
    Kerry

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Email: kseekircher@nwhc.net
    Phone: 914-666-1243
    Fax: 914-666-1013

Sign In or Register to comment.