Septic Shock and Severe Sepsis how to mark POA

If a patient comes in with severe sepsis which would be POA, but then later develops septic shock and (in this case) died.  The severe sepsis and septic shock are a combo code, so how do I mark the POA?  Would it be marked yes?  Or not present on admission since the shock was not but the sepsis was?  Thanks for any help you can give.  


  • Good question.  "All elements" of the condition coded need to be present on admission in order to assign a POA of 'yes'.

    REF:  Coding Guidelines 2019  (POA Section)

    ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page 120 of 120

    Codes That Contain Multiple Clinical Concepts Assign "N" if at least one of the clinical concepts included in the code was not present on admission (e.g., COPD with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission).

    So, I'd code

    1. Sepsis with POA of "Yes"

    2. R65.21 Septic Shock with POA of "No"

    Yes, this is a bit 'odd'.


    Paul Evans, RHIA, CCDS

  • Agree with Paul, Sepsis poa Yes, Severe Sepsis with Shock Poa No
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