Bacteremia

cmclose@saintfrancis.comcmclose@saintfrancis.com
in CDI Talk Archive
New at this CDI job, 2 months now. What is a good way to query to
clarify the diagnosis of bacteremia (Attending doctor and Inf. Disease
doctors are charting bacteremia)? Please email me ideas! Thank you!
(So much to learn, so little time :) )

Claudine Hutchinson RN
Clinical Documentation Improvement Coordinator
Children's Hospital at Saint Francis
Email: chutchinson@saintfrancis.com


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Comments

  • MelindascharfMelindascharf
    edited March 2016
    I always query to clarify what the MD suspects is the source of the bacteremia, as this can impact the drg. Our coders will not use bacteremia as a pdx unless the patient was called to come in because of positive blood cultures and no source is ever identified. I also look for s/s of sepsis (SIRS criteria) to make sure they are not documenting bacteremia instead of septicemia.
    Hope this helps!!



    Melinda Scharf RN CDS BSN

    ________________________________
  • lspryszaklspryszak
    edited March 2016
    Bacteremia: (790.7), a laboratory finding of viable bacteria in the blood without evidence of a systemic inflammatory response – does not equate to septicemia for coding purposes. Bacteremia is the “asymptomatic presence of bacteria in the blood” or in slang terms, “bugs in the blood”. A symptom code – look for the underlying condition/infection

    Example: Vigorous tooth brushing may cause bacteria in the mouth to enter the bloodstream.

    I would offer this definition and ask if this is what the provider intends with this diagnosis -- or is he/she treating a systemic illness, i.e., septicemia? But only query for septicemia if the patient appears sick AND meets clinical criteria.
  • wfreemanwfreeman
    edited March 2016
    I will be out of the office on Friday, February 11, 2011. If you need
    immediate assistance please contact the Case Management Department at
    636-933-1226. Otherwise, I will return on Monday, February 14, 2011.

    Thank you,
    Bill Freeman, RN, BSN
    Director of CDI
    Jefferson Regional Medical Center
    636-933-5324



  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    ALWAYS....INTERCHANGEABLY LIKE THEY MEAN THE SAME THING TO THEM.... WE EDUCATE.... OVER AND OVER... AND QUERY OVER AND OVER... DEPENDING ON INDICATORS, CLINICAL STATUS, TX, ETC.

    Not a new issue for us at our Hospital! :)

    Juli

  • jmontyjmonty
    edited March 2016
    Same here as well (using the terms interchangeably). Occasionally I will see a physician write sepsis and bacteremia together but it is not the norm, and far and few between.



    Julie Monty
    RN, CCDS
    HIM Dept.
    (518) 314-3476
    JMonty@cvph.org
    The University of Vermont Health Network
    Champlain Valley Physicians Hospital
    UVMHealth.org/CVPH


  • tpeytontpeyton
    edited March 2016
    We recently started using hospitalist. I am seeing bacteremia documented more frequently. They use it interchangeably with sepsis. I am working on educating but not having a lot of success at this point.

    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701

  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited March 2016
    Yes! Agree with Juli and Karen.
    Frustrating....

    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    The Children's Hospital at Saint Francis
    Email: chutchinson@saintfrancis.com
    Office: (918) 502-6603


  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited March 2016
    I rarely see Sepsis and Bacteremia documented separately any more.

    What I do see when there is a positive blood culture and SIRS criteria met some physicians write "Sepsis due to (known organism) Bacteremia" and will link this to other infectious sources as well such as cellulitis, UTI, Pneumonia, etc. that the patient may have.

    Is that okay?


    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

    Care first. Community always.

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    I have been in this field for over 20 years, and I saw 'bacteremia' and 'sepsis' noted concurrently when I began, and I continue to see the two terms used interchangeably today. I believe we will face this challenge until we all retire.





    H&P states this pt admitted with PNA and Empyema has SIRS



    Progress notes on Day 2 term this as 'sepsis' - progress notes on Day 3 thru Day 5 document "Bactermia'





    Discharge Summary makes no mention of "Bacteremia, SIRS, or Sepsis".





    For data purposes, these terms are not synonymous. Please indicate which term, if any, best describes the clinical course determined after study.





    [cid:image001.png@01D15F25.383CEA80]







    Paul Evans, RHIA, CCS, CCS-P, CCDS



    et, Danvers MA 01923
  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    According to 2016 CDI Pocket Guide: There is an Excludes 1 note category A41 that indicates Bacteremia, NOS (R78.81) can never be assigned together with sepsis. As a Chapter 18 symptom code intrinsic to sepsis, it cannot be assigned in preference to sepsis when sepsis and Bacteremia are both documented. When both documented, do not query for clarification since Bacteremia cannot be coded in this situation, If only Bacteremia is documented when sepsis criteria are met, always query to clarify the diagnosis of sepsis for correct coding.

    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax


    CDI Educator
    Clinical Documentation Integrity
    Medical University of South Carolina
    Phone:   843.876.0333
    Email:    bridgema@musc.edu

  • vanessa.falkoffvanessa.falkoff
    edited March 2016
    What Juli said :(
    This is our topic of the month! (attached)


    Vanessa Falkoff RN
    Clinical Documentation Improvement Coordinator

    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

    Compassion * Accountability * Respect * Integrity



  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    When both are documented, we query, unless the Attending calls this 'sepsis' as a final Dx. O/W, concurrent use of both terms could be considered as 'dissonance' in charting. The coding of Bacteremia is subject to a lot of nuanced coding rules, probably beyond what can be addressed via this forum.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421



    evanspx@sutterhealth.org



  • cynthia.hudson@christushealth.orgcynthia.hudson@christushealth.org
    edited March 2016
    I agree Paul. We also query when they are using both terms because coding will usually take the one they are most consistent with documenting in the record. This seems to be the never ending story despite continued consistent education.

    Syndi Hudson, RN, CCDS,CCM
    CHRISTUS Santa Rosa New Braunfels
    CDI Specialist
    cynthia.hudson@christushealth.org
    830-643-6116 (Office)
    830-643-5139 (Fax)
     
    “We are His hands”. Isaiah 64:8



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