COVID 19 and Sepsis
Just wondering your thoughts on this. Patient admitted with Interstitial pneumonia, acute respiratory failure, acute kidney injury. The interstitial pneumonia is documented as bacterial vs viral, COVID test results pending at this point but very much suspected. Would you query for Sepsis?
Comments
So, in your scenario, there must be a known or suspected concomitant infection, in addition to interstitial pneumonia, overlong the interstitial pneumonia?
IF there is some type of infection AND additional clinical support for “Sepsis”, a query for sepsis could be supported if it meets the criteria adopted at your site for “Sepsis”.
How are they treating the pneumonia? Does the patient have at least some supporting evidence there is an concomitant infection with the INTERSTITIAL pneumonia?
If the organ failures you cite are associated with an infection, it would seem SOFA criteria for Sepsis are met.
Paul Evans, RHIA, CCDS
Thanks,
Amy Fenton RN CDI
Others may have different opinions, but if a patient with an infection is septic from that infection, the systemic process is the principal diagnosis, which makes sense clinically and this same concept has been consistently stated by Coding Clinic for decades.
Paul Evans, RHIA, CCDS
Thank you Evan for sharing your thoughts and I completely understand your thought process but.....
I have a question regarding sequencing of Sepsis and COVID-19. We were recently instructed per a speaker on a recent webinar to follow the tabular index and sequence COVID-19 (U07.1) as PDX and Sepsis as a secondary since it supersedes coding guidelines. We were instructed that U07.1 is only a secondary code for neonates and OB. Any thoughts?
Ref: ICD Official Guidelines, April 1, 2020, through September, 30, 2020
For a COVD-19 infection that progresses to sepsis, see section I.C.1.d, Sepsis, Severe Sepsis, and Septic Shock.
Paul Evans, RHIA, CCDS
Section I.C.1.d.
If the reason for admission is both sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis. If the patient has severe sepsis, a code from subcategory R65.2 should also be assigned as a secondary diagnosis. If the patient is admitted with a localized infection, such as pneumonia, and sepsis/severe sepsis doesn't develop until after admission, the localized infection should be assigned first, followed by the appropriate sepsis/severe sepsis codes.
Above states if a patient is admitted with a 'localized' infection, such as pneumonia or cellulitis, the code for the systemic infection is assigned first. (the systemic infection is the sepsis).
IF only a local infection is present at admit, and the patient later becomes septic, the sepsis is not the PDX as it was not POA.