Endocarditis as PDX or Sepsis?
Hello all,
Back in 2009 there was a question on this forum about endocarditis as PDX vs Sepsis. We have had 3 recent cases @ our facility, and would like to know how best to code them. Pts have vegetation on valves, sepsis clearly documented as d/t Endocarditis. All d/c home on long-term IV abx. Coding clinic rules seem to indicate that sepsis would be documented as PDX, but some info from "Briefings on Coding Strategies" seems to imply that the endocarditis should be the PDX.
Any thoughts/advice on this one? Also, please cite specific coding references, if possible.
thanks!
Becky Mann, RN, CDS
Sutter Solano Medical Center
Back in 2009 there was a question on this forum about endocarditis as PDX vs Sepsis. We have had 3 recent cases @ our facility, and would like to know how best to code them. Pts have vegetation on valves, sepsis clearly documented as d/t Endocarditis. All d/c home on long-term IV abx. Coding clinic rules seem to indicate that sepsis would be documented as PDX, but some info from "Briefings on Coding Strategies" seems to imply that the endocarditis should be the PDX.
Any thoughts/advice on this one? Also, please cite specific coding references, if possible.
thanks!
Becky Mann, RN, CDS
Sutter Solano Medical Center
Comments
mentioned indicating the endocarditis should be the PDX?
My opinion is that the Sepsis is the PDX, as per the Official Guidelines
for SIRS/Sepsis - I am working remotely (traveling) at the moment, and
don't have access to the Official Guidelines for SIRS. But, these
state something to the effect that 'when a pt is admitted with an
infectious process (such as PNA) and has Sepsis on admit, the SIRS is
the PDX."
If any doubt, I would send a copy of the case to AHA and ask for
official clarification.
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
the Sepsis should be the Principal Diagnosis, per the Official
Guidelines. I would be interested to see the logic cited elsewhere.
3) Sepsis/SIRS With Localized Infection
If the reason for admission is both sepsis, severe sepsis, or SIRS and a
localized infection, such as pneumonia or cellulitis, a code for the
systemic infection (038.xx, 112.5, etc) should be assigned first, then
code 995.91 or 995.92, followed by the code for the localized infection.
If the patient is admitted with a localized infection, such as
pneumonia, and sepsis/SIRS doesn't develop until after admission, see
guideline I.C.1.b.2.b).
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
not the PDX if/when the pt is admitted with an infectious process.
(However, there are times a pt may have SIRS, and the SIRS is not the
PDX, but this is not typical - such as, admitted some other process
that is not infectious, and meets guidelines for PDX.
Example: AMI with Cardiogenic shock, Catastrophic CVA, and also has
SIRS).
But, with bacterial Endocarditis, I do believe we are compelled to use
SIRS as PDX if stated as due to this infection. If some other
publication has stated other logic, it would be interesting to review
and consider?
(The nonessential term found under 421.0 (septic), does not mean sepsis
is not coded or is not coded as the PDX.
Just as with 'septic arthritis', it directs us to use these codes when
the record indentifies 'septic' Endocarditis. So, just as the term
'septic' arthritis and/or 'septic' Endocarditis does mean the patient
has Systemic Inflammatory Response Syndrome. However, if the pt has
SIRS due to the 'septic' Endocarditis, the SIRS must be the PDX.
IMO -
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
Unfortunately there is a conflict between the two.
Perhaps someone has access to/membership to Briefings on Coding Compliance Strategies newsletter, and can search that website?
Thanks,
Becky Mann, RN, CDS
Sutter Solano Medical Center
But, I don't have access to the other document you are referencing -
given that we are sharing information on this HCPRO website and that the
2nd document is generated by HCPRO, perhaps someone from HCPRO can join
the conversation.
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
"So, the term septic arthritis and/or septic Endocarditis does NOT mean the patient has Systemic Inflammatory Response Syndrome. However, if the pt has SIRS due to the septic Endocarditis, the SIRS must be the PDX."
The description in the coding book for "septic" endocarditis or 'septic' arthritis does not mean a patient has SEPSIS or SIRS due to infection. If a pt does have SIRS or SEPSIS due to an infection, the sepsis is the PDX. Some have stated that the term 'septic' endocarditis indicates that Sepsis is not coded - and the logic stated is the use of 'nonessential modifiers'. I don't agree with this intrepretation, and believe these terms indicate that the code for the condition is assigned, but if the pt has SEPSIS, sepsis is coded.
Angie Mckee, RHIT, CCDS, CCS, CCS-P
Clinical Documentation Specialist
Performance Improvement
University Health Care System
Augusta, Ga. 30901
706-774-7836
this IS Sepsis, and sepsis will be the PDX, by default. I did not think
I needed to say that (again).
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739