Lactate acidosis and Sepsis
It's been 7 years since Allen wrote this article that addresses coding lactate acidosis (E87.2-) and sepsis together. What are current thoughts about this? (Had to condense due to length).
May 30, 2019 CDI Strategies - Volume 13, Issue 24
Q: Is lactic acidosis considered integral to the diagnosis of sepsis?
A: In summary, vanilla sepsis would be code A41x with no R65 code in a patient with an elevated lactate. You’ll have questions and likely need to issue a query here. Why is the lactate elevated? Perhaps the patient actually has severe sepsis? Is it septic shock? Do they have some other organ or metabolic problem raising the lactate levels and if so, what is it?
- Mild levels of elevated lactate with a documentation of sepsis: This is clinically a routine finding which would make it not separately reportable under ICD-10.
- Severe elevated levels of lactate with mild sepsis and an A41x code, but no R65.x code and no organ/metabolic disruptions to explain the lactate levels is a disconnect that requires a query. The clinical circumstance is incongruent with the code assignment you are looking at. Continued severely elevated lactate levels indicates you are missing the severity of the sepsis, additional organ failures, other metabolic problems or all of the above.
- Septic shock with severely elevated lactate levels, anion gap, etc. would again be a routinely associated finding in septic shock and therefore not reportable by basic coding guidelines.
- Severely elevated lactate levels with acidosis in a patient with documented causes for the lactate other than sepsis would create a situation where the additional acidosis may be reportable (assuming it is not an expected finding for the other diagnoses as well).
Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for HCPro in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps, click here.