Sepsis and Code Sequencing
I have a case where the patient is admitted with Sepsis due to e coil UTI, had a NSTEMI and GI bleeding found to be caused by Acute Duodenal Ulcer with ABLA. I had the E Coli Sepsis sequenced as primary diagnosis. My coder would like to change primary from sepsis to the bleeding duodenal ulcer (which increases the DRG). I asked for a coding clinic or coding rule that stood behind that as I have always been taught the Sepsis trumps almost anything. She said that Sepsis does not trump another non-infection, specifically "2 or more conditions that are equally being treated and one is not an infection (such as sepsis and AML) either can be sequenced as PDX" This goes against what I've been taught and the practices I have always adhered to in CDI. I was wondering if you all could give some feedback on this?
Thanks!
Peggy
Thanks!
Peggy
Comments
Brief response: I agree w/ coder. The sepsis sequencing applies 'if' an infection caused the admit, then the sepsis must be PDX rather than the localized infection.
IF septic pt admitted with conditions not related to sepsis, such as stroke, AMI, then the rule she cites may be invoked, although not w/o restrictions and very, very careful deliberation and consideration of intensity of service, diagnostic w/u, etc.
Paul Evans, RHIA, CCDS
Agree with Paul. Also, what was the scope of care? Were any procedures aimed at the ulcer? Sepsis is usually your PDX, but with other co-equal conditions, it can get tricky.
Jeff
generally speaking, sepsis 'trumps' other diagnosis because when a patient has sepsis POA, this is typically the reason for admission. If is fairly rare that the reason for admission and focus of care are another unrelated dx.
That being said, there are times where this is the case and in these specific cases the other dx may be sequenced first.
It is a misinterpretation of the coding guidelines to assess that Sepsis is ALWAYS the Pdx when POA. That guidelines is specifically addressing sepsis and the related underlying infection.
Katy