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PVT 0715 Tool

dmal,la,

Uploaded by

syaiful rinanto
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Sepsis Coding Decision Tree in ICD-9 and ICD-10

Follow the directions specified in this tool, created by Brandi Whitemyer, HCS-D, product specialist for DecisionHealth
in Gaithersburg, Md., to help you assign the right code(s) for sepsis and related conditions.

What’s the diagnosis in ICD-9? What’s the diagnosis in ICD-10?


• Bacteremia – Code 790.7 (Bacteremia); use an additional • Bacteremia – Code R78.81 (Bacteremia).
code to identify causative organism (041.x, Bacterial infection in • Septicemia – There is NO code for septicemia in ICD-10.
conditions classified elsewhere and of unspecified site). Instead, you’re directed to a combination ‘A’ code for sepsis to
• Septicemia – Choose a code from 038.xx (Septicemia) indicate the underlying infection, such A41.9 (Sepsis, unspecified
depending on the information given. organism) for septicemia with no further detail. Note: ‘A’ codes
for Sepsis in ICD-10 include both the underlying infection
◦◦ Is sepsis also present?
(septicemia) and the body’s inflammatory reaction.
▪▪ Yes. – also assign 995.9X (Sepsis or Severe Sepsis)
• SIRS (Systemic inflammatory response syndrome) –
▪▪ No. – 038.xx code is sufficient Tip! Query physician to
verify that no diagnosis of Sepsis is present. In ICD-10, ◦◦ First, determine if the SIRS is related to an infectious origin.
Septicemia may not be coded alone (codes for Sepsis ▪▪ If Yes, assign a code for Sepsis.
include Septicemia).
• Follow instructions for Sepsis coding and determine
• SIRS (Systemic inflammatory response syndrome) – if organ dysfunction is present. If it is, you’ll need to
Identify the underlying trauma or infection then choose a code include a code from R65.2-, Severe Sepsis.
from 995.9x (Systemic inflammatory response syndrome (SIRS))
▪▪ If No, assign a code first for the underlying cause of the
depending on the information given. SIRS (such as T67.0- for heatstroke), followed by R65.1-
◦◦ SIRS is defined as a clinical response to an insult, infection or for SIRS of non-infectious origin.
trauma. The causative infection or trauma should be coded • Sepsis – Choose the correct ‘A’ code to indicate the sepsis.
first. Tip! 995.9x codes may never be assigned as primary! Simply locate the code for the correct type of infectious process
• Sepsis – Code first the underlying systemic infection, such as that is causing the sepsis, such as A41.51 (Sepsis due to
038.0 (Streptococcal septicemia), and then assign 995.91 for Escherichia coli [E. coli]). Note: The underlying systemic infection
the sepsis and the body’s inflammatory response to it are captured in one
• Severe sepsis – Code first the underlying systemic infection, combination code.
such as 038.0 (Streptococcal septicemia), then code 995.92 for • Severe sepsis – First choose the correct code for the underlying
severe sepsis, and finally code the specific type of organ failure, infection, such as A41.51 (Sepsis due to Escherichia coli [E.
such as 584.9 for acute renal failure. coli]), then code the severe sepsis, such as R65.20 (Severe
sepsis without septic shock) and then assign an additional code
◦◦ Tip! Severe Sepsis is defined as Sepsis with associated
organ dysfunction. for the organ dysfunction it’s causing, such as K72.00 (Acute and
subacute hepatic failure without coma).
• Septic shock – Code first the underlying systemic infection,
such as 038.0 (Streptococcal septicemia), then code 995.92 • Septic shock — Code first the underlying infection (for
for severe sepsis, then code 785.52 for septic shock and finally example A41.51, Sepsis due to Escherichia coli [E. coli]), then
assign the code for the specific type of organ failure inherent to code the severe sepsis combination code that indicates the
septic shock, such as 584.9 for acute renal failure. presence of septic shock (R65.21, Severe sepsis with septic
shock) and lastly code the associated organ failure (such as
J96.00, Acute respiratory failure, unspecified whether with
hypoxia or hypercapnia).

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