overdose vs. sepsis
Hi guys,
I wanted to ask you something. if overdose and sepsis are both mentioned and POA. What do you guys place as principal? thnx
I wanted to ask you something. if overdose and sepsis are both mentioned and POA. What do you guys place as principal? thnx
Comments
It could be mentioned but if there is no toxic level then its then theres no poisoning. However, if there is a postive chemical in lab and it is injested in an incorrect way (as long its not adverse)...
This has been discussed in previous posts and the advice is that if the sepsis is a manifestation of the poisoning, the poisoning should be sequenced as principal. (Poisoning -> Aspiration pneumonia -> Sepsis.) If they are two separate and distinct processes. Either could be assigned as principal. (UTI -> Sepsis -> Poisoning).
ICD-10-CM Official Guidelines for Coding and Reporting
Section I. Conventions, general coding guidelines and chapter specific guidelinesC. Chapter-Specific Coding Guidelines
19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
e. Adverse Effects, Poisoning, Underdosing and Toxic Effects
Codes in categories T36-T65 are combination codes that include the substance that was taken as well as the intent. No additional external cause code is required for poisonings, toxic effects, adverse effects and underdosing codes.5) The occurrence of drug toxicity is classified in ICD-10- CM as follows:
(b) Poisoning
When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings.
It is a very complicated question that can't really be addressed without detailed discussion of clinical findings and circumstances of the admission. As others stated, 'often' with an O/D, we have aspiration pneumonia as a consequence that leads to Sepsis. IMO, the O/D is the PDX in that situation.
Theoretically, a person could be admitted with an O/D and also have as a totally separate clinical process some infection, such as a complicated UTI that is ALSO causing sepsis; the charting would have to be very clear the sepsis is not related to the O/D if one wanted to use the Sepsis as the PDX.
IF I were trying to use Sepsis rather than the O/D, I would search for acute organ dysfunction that would permit me to code Severe Sepsis as this lends strength to the choice of sepsis rather than the OD. This would not be a typical circumstance, IMO.
I know that Sepsis 3 does not recognize "Severe" Sepsis, but applying the R65.20 to indicate Severe Sepsis strengthens any claim for sepsis, particularly in this circumstance.