Circumstance in which sepsis not the principal dx

 OCG: sepsis (even though POA was not principal reason for admission (did not meet definition of principal)-

can anyone give an example of when this would be true?

Acute Appendicitis w rupture and peritonitis with sepsis POA. Principal: Sepsis, correct?

Thanks in advance for any responses


  • That's correct, sepsis will be your principal diagnosis. The only time you will not use sepsis as primary diagnosis is when there is a complication code on admission.

  • We always have this debate when it comes to Endocarditis and Sepsis.  Any thoughts?
  • what about a situation where there is sepsis and an infection following a procedure from over a month ago.  Do you code the sepsis primary or the T code for infection following a procedure? 
  • We had an instance of a patient who came in with respiratory failure due to dka.  The patient also had sepsis due to uti.  The patient was intubated and ventilated.  Our Pdx was Resp failure, Proc code was the vent, sepsis was our mcc.  The payer tried to argue that the sepsis should have been pdx, but it was overturned in our favor based on the physician's documentation of 2 diagnoses equally meeting criteria for pdx.
    We also use sepsis as mcc when the sepsis is due to complication such as catheter related uti.  The complication is pdx.  Not sure about the 'over a month ago' situation, but I would same the same for that.
  • I think I am more amazed that you won your case with the respiratory failure as pdx Betty!  thank you for your input.  I do know that tube or device related infection trumps Sepsis, but didn't have the knowledge that other complications potentially would also
    • General Coding Guidelines ICD-10-CM Official Guidelines for Coding and Reporting 16. Documentation of Complications of Care
      • Code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure. The guideline extends to any complications of care, regardless of the chapter the code is located in. It is important to note that not all conditions that occur during or following medical care or surgery are classified as complications. There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. Query the provider for clarification, if the complication is not clearly documented.
    This is advice from our vendor:
    • Sepsis that is associated with a urinary device, such as a foley catheter is considered a complication of care.
    • A “complication” diagnosis is assigned as the PDx rather than UTI or sepsis.
    • Do not assume a link between an infection and a device; the physician must establish the relationship between the device and the infection in the medical record document.
    • With the “complication” diagnosis established in the documentation, apply the sepsis (or UTI) as a secondary diagnosis.
    • The diagnosis of a urinary catheter associated infection is considered a potential hospital acquired condition (HAC); if the condition was present on admission (POA) remember to ensure that the documentation explicitly reflects this important information.
  • I had situation recently patient admitted with diagnosis of atrial fib.    That patient had previously been admitted and was still under treatment for sepsis and treatment was continued on the new admit.    In that case my question is would you be able to use the sepsis as a secondary diagnosis since was still being monitored and treated,  but wasn't the cause of admission. 
  • Is the patient still septic, or is the treatment and monitoring ongoing for the localized infection that caused the septic episode?   I would guess that the sepsis was resolved on discharge unless he was transferred to another acute hospital that took over care and then was transferred back (?)
  • RE: Endocarditis and Sepsis:  If pt has infective form of endocarditis, in my view, sepsis is the principal condition and diagnosis code.  Ref:  Coding Guidelines for Sepsis which refer to 'localized infection' in a septic patient.  Curious as to other thoughts or rationale for using an infective form of endocarditis as the PDX rather than sepsis if both are present on admit?

    Paul Evans, RHIA, CCDS

  • What about when you have Sepsis and a NON-infectious OTHER potential PDX- example- NSTEMI with intervention and Sepsis , or alcholic cirrhosis with TIPS/Stent and SEpsis- POA and meeting criteria.
  • I have seen instances of very unfortunate individuals admitted with such concurrent conditions as acute CVA,  Sepsis due to an infection, and acute myocardial infarcts due to CAD (not a type 2 associated with infection).

       There was strong clinical evidence of each acute condition, but the patients were made Comfort Care and shortly after died.  In my view, the sepsis was not required be the CVA in each circumstance.

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