Bacteremia as PDX when the Blood culture comes back as a contaminant
Scenario: Pt called back to the ED for a positive Bld Cx taken the day before. Patient admitted and put on I.V ABX. The re-culture comes back negative and the positive blood culture from the day before was deemed a contaminant. Abx stopped and the patient is discharged. Can Bacteremia still be uses as PDX even though the blood culture was a contaminant?
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Since there is no clinical bacteremia, no form of bacteremia should be coded.
I would see an argument for bacteremia if the patient was treated based on the initial blood culture for the appropriate length of time. We see this many times in pediatrics. There will be a positive culture (probably a contaminant) and based on age or comorbid conditions the patient will be treated with IV antibiotics for the appropriate length of time based on the pathogen.
Thanks, Jeff
if it was still on the differential at discharge, you could code it. But if the condition is ruled out, it cannot be coded at all, let alone as Pdx....
Katy
Volume 4 Fourth Quarter
Number 4 2017, Page 26
ICD-10-CM NEW/REVISED CODES
Summary explanations of the Fiscal Year 2018 (FY 2018) ICD-10-CM changes effective October 1, 2017 are provided below. Addenda changes demonstrating the specific revisions to the code titles or instructional notes are not included in the explanations below. The official ICD-10-CM addenda has been posted on the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website at http://www.cdc.gov/nchs/icd/icd10cm.htm.
There are 360 new ICD-10-CM codes implemented on October 1, 2017. In addition, 141 codes have been deleted and 226 code titles revised.
Z Code Update
New Z codes have been created as noted below.
Observation
The Excludes1 note at category Z03, Encounter for medical observation for suspected diseases and conditions ruled out, referring “newborn observation for suspected condition, ruled out,” to categories P00-P04 has been deleted. A new Excludes1 note has been added to refer such cases to category Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out.
Skin Contamination and Blood Cultures
There are really only four bugs that are commonly contaminants when blood cultures are positive:
While these are commonly contaminants, be careful to rule out true infection in the following settings:
The following bugs are generally NOT skin contaminants are warrant further workup:
I am not disputing the contaminant. MD's do not know this when they admit and are required to treat. There is a cost for this treatment. Should this cost be less because the Bacteremia that was treated was a false positive?
It's fairly common that we have suspected conditions that require resources (radiologic studies, medication, etc), that then end up being ruled out.
We cannot code conditions that are no longer on the differential at discharge.
Katy
Bottom line is the coding must align with clinical reality. Having said that, I could list for days those clinical situations by which the payments seem unjust? Have you ever considered your charges for severe sepsis (ICU) and considered the R.W.? When a young woman that is pregnant is septic, why are we paid even less for managing her care as compared to a male of the same age?
Paul Evans, RHIA, CCDS
Off topic but since you brought up obstetrics Paul (lol)...it is very frustrating to have to sequence an "O" code as PDX on some of these pregnant patients who are very resource intensive. Trauma is very frustrating, especially those who should be in a MST DRG but end up in an OB DRG.
Ok, I am down off the soap box. Coding and the clinical reality are not congruent and that's something we all struggle with.
Agreed, it's the RW...I wish no one was allowed to use MS-DRG's for OB, peds or neonates!
Love these discussions !!! TY everybody