sequencing of sepsis and complication codes

Second Quarter 2020 coding clinic states that Vent associated pneumonia is considered a localized infection and should be sequenced as a secondary diagnosis when sepsis is present.

Would this coding clinic be interpreted to include a  catheter associated UTI and sepsis? What are the sequencing guidelines for Sepsis secondary to a cath associated UTI? We have always sequenced the complication code as principal. Coding is now stating that Sepsis should be sequenced as the principal diagnosis based on the above coding clinic. Any advice would be appreciated.

Thank you!


  • I just came across this coding clinic and have the same question! I think it definitely confuses the issue. Looking forward to a discussion on this.

  • I would go back to the definition of principal diagnosis.  I quote the Pinson & Tang Pocket Guide, "When treatment is totally or primarily directed toward one condition, or only one condition would have required inpatient care, that condition would be designated as principal diagnosis."  Also, "...since it is not necessarily the admitting diagnosis, but rather the diagnosis found after diagnostic workup that proved to be the primary reason for or focus of the admission".  UTI's are not necessarily a severe enough condition that requires inpatient care while Sepsis is.  Also ask yourself, where are most of your resources during the stay focused on, the UTI or the Sepsis?  Just my thoughts, hope it helps.

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