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ED Coding and Reimbursement Alert

Reader Question:

Sepsis vs. Symptoms

Published on Thu Jun 01, 2000

Question: When coding to rule out sepsis on a pediatric emergency room (ER) visit, can we code sepsis, or can we code only the symptoms?

Marisha Barton
Salt Lake City, Utah

Answer: Rule out diagnoses cannot be coded using any ICD-9 codes. If, in the physicians mind, the patient does have sepsis (038.9), even if it is disproved after admission, then code sepsis. If the physician cannot make that determination, then code the symptoms and comorbidities. Do not code rule out. If physicians persist in listing this type of diagnosis, an educational session needs to be held with them to inform them of what is and is not possible.
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