SIRS and viral gastroenteritis

allison.wilson@pardeehospital.orgallison.wilson@pardeehospital.org
in General
Discussing with the coders that SIRS does not get coded because the viral gastroenteritis is an infection so therefore SIRS would not be coded. I'm debating that is not an infection and SIRS should be coded.  My example was pancreatitis??  Please give me your thoughts. Thank you, Allison Wilson CDS 
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  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    SIRS, as you indicate, no longer equates to sepsis, and may be present in the setting of burns, trauma, heat stroke.   It 'can' be coded, to R65.1X series.

    Pancreatitis does have infectious forms, such as necrotizing pancreatitis with abscess, and in can cause Sepsis.

    There are 'many' types of pancreatitis, such as infectious, and that which is not infective, such as  alcohol-induced, cystic, drug-induced, etc.  So, one key in regards to Pancreatitis and potential 'Sepsis' is determining the classification of the pancreatitis. 

    I know there is an old Coding Clinic about Pancreatitis and SIRS, and it does not cover ALL types of pancreatitis, ignoring the fact that some forms of pancreatitis cause significant infection that can result in Sepsis.

    Some forms of gastroenteritis are also infective, such as Viral, Salmonella, Clostridium, and as such, sepsis may result from type of infectious enteritis.  Your question stated the patient has VIRAL gastroenteritis, and this IS an infection coded to A08.4, Infectious Disease; I am not an MD, but can state I have seen Sepsis can be caused by a virus.

    Best


    Paul Evans, RHIA, CCDS

  • allison.wilson@pardeehospital.orgallison.wilson@pardeehospital.org
    Thank you for your information. A query was sent to determine if patient had Sepsis, the answer to the query was SIRS without organ dysfunction and was due to the viral gastroenteritis. The coders are saying we can't code SIRS because this was an infection.  Is any was else doing this?  
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited January 2019

    I understand now your predicament with your last statement.  This is complicated, and the confounding issue is the way the MD is using the term SIRS, at least in my opinion. (I say this because the patient has a viral infection and the MD charted SIRS).


    But, to answer your question, the coders are correct in that there is no longer a pathway to code 'SIRS due to an infection' as a disease. 

    Several years ago, the term SIRS w/ infection defaulted to Sepsis - but, no longer.  I understand why MDs are confused and frustrated with CDI/Coding because for years they were told to use the term SIRS with infection, when clinically supported, and with the thought this would be reported as sepsis.  So, our industry caused some of this confusion.

    If/when an MD uses the term SIRS  with infection AND a query for Sepsis IS supported, perhaps issue a query perhaps with some choices such as:

    SIRS resulting in Sepsis with infectious process
    Localized infection only, with systemic process
    Unable to Determine
    Other

    A SIRS query for something like burns or trauma is a different issue. 

    Hope this helps?

    PE

  • allison.wilson@pardeehospital.orgallison.wilson@pardeehospital.org
    Thank you for your information. A query was sent to determine if patient had Sepsis, the answer to the query was SIRS without organ dysfunction and was due to the viral gastroenteritis. The coders are saying we can't code SIRS because this was an infection.  Is any was else doing this?  
    Thank you for your information. A query was sent to determine if patient had Sepsis, the answer to the query was SIRS without organ dysfunction and was due to the viral gastroenteritis. The coders are saying we can't code SIRS because this was an infection.  Is any was else doing this?  


  • allison.wilson@pardeehospital.orgallison.wilson@pardeehospital.org
    allison.wilson@pardeehospital.org said:
    Thank you for your information. A query was sent to determine if patient had Sepsis, the answer to the query was SIRS without organ dysfunction and was due to the viral gastroenteritis. The coders are saying we can't code SIRS because this was an infection.  Is any was else doing this?  
    Thank you for your information. A query was sent to determine if patient had Sepsis, the answer to the query was SIRS without organ dysfunction and was due to the viral gastroenteritis. The coders are saying we can't code SIRS because this was an infection.  Is any was else doing this?  


    Thank you so much for the information. Allison Wilson RN, CDS
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