Bacteremia without SOFA criteria

proddy@clarionhospital.org

What are you all doing with Bacteremia (blood cultures grew out Kleb Pneumoniae) in the absence of SOFA criteria/organ failure?  This is an insurance that strictly adheres to Sepsis 3/SOFA criteria.  Patient also has a UTI which grew out the Kleb Pneumo.

lharbison

HI,

If there is no SOFA criteria, I would think that I would just pick up the UTI as the PDX and the Bacteremia and Kleb Pneumoniae as secondary diagnoses.  If there are no clinical indicators for sepsis then there really isn't anything to offer in a compliant query.

jackietouch@aol.com

lharbison said:

HI,

If there is no SOFA criteria, I would think that I would just pick up the UTI as the PDX and the Bacteremia and Kleb Pneumoniae as secondary diagnoses.  If there are no clinical indicators for sepsis then there really isn't anything to offer in a compliant query.

I would do the same.

lprescott1

Bacteremia merely is defined as "bacteria present in the blood".  We all likely have some bacteria in our blood. it does not equate to sepsis, nor does the absence of bacteria in a blood culture tell us the patient is not septic. Look at it as symptom which helps you better understand the big picture. I would code the UTI and bacteremia as a secondary diagnosis and would not query for sepsis unless I saw clinical indicators to support its presence. 

shivanisobat@hotmail.com

lprescott1 said:

Bacteremia merely is defined as "bacteria present in the blood".  We all likely have some bacteria in our blood. it does not equate to sepsis, nor does the absence of bacteria in a blood culture tell us the patient is not septic. Look at it as symptom which helps you better understand the big picture. I would code the UTI and bacteremia as a secondary diagnosis and would not query for sepsis unless I saw clinical indicators to support its presence. 

I would do the same .

proddy@clarionhospital.org

Thanks for your input!  That's what I have done as well.  My coder has some concern because the bacteremia then ends up being an only "cc" on the chart and she mentioned a coding rule with reference to being considered a symptom.  Any input there?

morris-jeff@CooperHealth.edu

When we all went through ICD 10 education, many people got hung up on the fact that they kept saying “bacteremia is a symptom” and acted like it shouldn’t ever be coded. Many times patients do present with bacteremia and do not even meet SIRS criteria and are indeed treated for bacteremia due to certain co-morbidites or their age, etc.. bacteremia is certainly a trigger to look for Sepsis indicators, but if it’s not there, then it’s not there. If resources were spent on treating the bacteremia, repeat cultures, etc...then it definitely meets the UHDDS definition for a secondary diagnosis. 

lprescott1

I agree with Jeff. I would also say the bacteremia should likely never be your principal diagnosis.