SEPSIS VS BACTEREMIA

kclemens

We're battling the sepsis vs. bacteremia game and looking for suggestions/ideas on this subject?  Can bacteremia as well as sepsis be coded on same chart?  Ex:  pt initially had staph in blood then progressed with AKI, PNA; leading to sepsis.  Is it ok in this situation to code both or what's the recommendations on this?  Any help would be appreciated!  Thanks in advance!

aliciasmail@twc.com

I am interested to hear what others have to say as well since we are currently discussing this at our organization.  Coding says that bacteremia "with" sepsis is an automatic link and the physician would have to document that the bacteremia was not related to sepsis in order to code them separately.  if CDI queries for the underlying cause of the sepsis (including the choice of the bacteremia) and they state sepsis d/t pna or some other infection then is that not "unlinking" the bacteremia from the sepsis allowing us to code both?

thank you

evanspx@sutterhealth.org

Will try to do this justice.

If the patient has E. Coli “Bacteremia” and the patient is septic with E. Coli, then only sepsis is coded as the code for Bacteremia would be redundant. 

In the rare situation in which a patient has true bacteremia (not contaminant) that is not causing sepsis, it is coded as Bacteremia.  (Bacteremia due to PNA, as example, is coded as 1.  PNA 2. Bacteremia.  (Again, only if this is truly bacteremia w/o sepsis - Bacteremia is a sign/symptom coded).  See coding conventions for coding of signs/symptoms.

I just had a case in which a patient presented with valid bacteremia due to cellulitis, and the patient became septic AFTER admission, with the MD stating the same organism caused the bacteremia and sepsis.  (Met SOFA AFTER admission).

Coding Assignment
1.  Cellulitis with a POA of “Yes”
2.  Sepsis with a POA of “N”

No code for the Bacteremia, redundant.  Each case is unique.

whitneyarellano

If it's the same infection/organism causing the bacteremia and the sepsis, you only code the sepsis as bacteremia is a symptom. To get around the excludes 1 note, the bacteremia and the sepsis would have to be explicitly unlinked in the documentation, i.e. Pt admitted with UTI and E coli bacteremia, later develops pneumonia with respiratory culture positive for MRSA and becomes septic and MD links sepsis to pneumonia, you could code UTI (POA), E Coli (POA), and bacteremia (POA), as well as sepsis due to MRSA (not POA), and pneumonia due to MRSA (not POA). It would have to be very clear in the documentation that the sepsis and bacteremia are unrelated, though.

evanspx@sutterhealth.org

Good explanation 

sdemello@hhsc.org

What happens when the patient is called back to the ER for postive blood cultures and the MD documents E. coli bacteremia secondary to UTI.    In this case is it safe to go with the bacteremia and principle... reason for patient being called back

evanspx@sutterhealth.org

No..Bacteremia is a symptom..the cause of the symptom (infection site) is coded as the principle diagnosis.  As above, IF we get a ‘call back to ED” 2/2 bacteremia AND the patient has clinical signs/symptoms and treatment consistent with “Sepsis”, we’d need to issue a queue for SEPSIS, which if confirmed by MD query response, is the principle.