Wiki Help with Sepsis Proteus Mirabilis Due To UTI

[zmashchak]

I do not know how to code for sepsis Proteus Mirabilis due to a UTI. How do I code for this???

I did look up some codes in the ICD-10-CM book, but all I could find for Proteus Mirabilis was B96.4. This code does not include the sepsis. I am so confused because Proteus Mirabilis is a gram-negative, anaroebic bacteria. Does this mean I use a code for sepsis due to anaerobes (A41.4) for the sepsis? Or do I use A41.89 (other specified sepsis) for the sepsis? Or do I simply use the B96.4 code? Thank you in advance for any suggestions!

 

[kcarlyle]

How about A41.59 other gram negative sepsis with N39.0 UTI?

 

[zmashchak]

Codes Finally Used

Thank you for your suggestion! It helped me get started on the right track.

I finally decided to use 3 codes. For the sepsis, I am using A41.59 (Other Gram-Negative sepsis). For the Proteus Mirabilis, I am using B96.4 (Proteus as the cause of diseases classified elsewhere). For the UTI, I am using N39.0.

 

[kcarlyle]

I don't think you need B96.4. Below is a link for an article about coding Sepsis that I've found helpful.
https://www.aapc.com/blog/31689-sepsis-and-sirs-code-it-right-in-icd-10-cm/

 

[zmashchak]

Explanation Please

Would you please explain to me why you believe it is not necessary to use the B96.4 code? Thank you.

 

[kcarlyle]

The organism is included in the sepsis code A41.59

 

[mitchellde]

If you look in your guidelines for Sepsis it states:
(a) Sepsis
For a diagnosis of sepsis, assign the appropriate code for the underlying systemic infection. If the type of infection or causal organism is not further specified, assign code A41.9, Sepsis, unspecified organism.

The Proteus is the underlying infection.

Also there is a note with the A41 category indicating that other codes should be coded first. In other words A41 codes are secondary only.
Use the B96.4 followed by the A41.4 then the N39.0

 

[kcarlyle]

Codes B95 - B97 are "for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere" per the "Notes" section of the ICD-10 manual.

 

[mitchellde]

I looked all over for that note and then decided I was mistaken and it was not there! Thanks for pointing it out I guess now you would need to use the N39.0 as first listed?

 

[zmashchak]

Correct Code Sequencing

What if you put the A41.59 code first, then the N39.0 code next, and the B96.4 as the last code? Would this be more correct than simply putting A41.59 followed by N39.0? It seems to me that the sepsis is the systemic infection, the UTI is the localized infection, and the Proteus Mirabilis code is further describing the cause of the UTI. Any thoughts anyone?

 

[mitchellde]

I have done some reading and comparing of codes on this... Had this been ICD-9 CM you would have coded the code for the septicemia first and then the 995.91 for sepsis due to infection. And at first glance the ICD-10 CM guidelines do not appear to be much different. However the codes lead us a different way. The A41 codes have a note for code first and it is not an open ended code first "such as" kind of note. It leads me to now believe that one of the listed diagnosis must be present and coded first. This would leave out this scenario. If you look at the R65.1 sub category for SIRS of non infectious origin, the excludes 1 note states:
Sepsis - code to infection
The infection here is the UTI the organism is the proteus mirabilis. So code the N39.0 first listed and the B96.4 secondary. That is my final choice.

 

[kcarlyle]

Below is an example from an AAPC article:

Documentation issues: Septicemia is rarely a term physicians document, and to reflect this shift in terminology, the term “septicemia” in ICD-10-CM’s alphabetic index refers you to “sepsis.” Various causative organisms and septic conditions are listed under the entry.
Example: A 39-year-old woman is admitted with high fever, malaise, and myalgias. Blood cultures and urine cultures taken on admission are positive for E. coli. The patient is diagnosed with septicemia and UTI due to E. coli.
A41.51 Sepsis due to Escherichia coli [E. coli]
N39.0

https://www.aapc.com/blog/31689-sepsis-and-sirs-code-it-right-in-icd-10-cm/

 

[mitchellde]

Below is an example from an AAPC article:

Documentation issues: Septicemia is rarely a term physicians document, and to reflect this shift in terminology, the term “septicemia” in ICD-10-CM’s alphabetic index refers you to “sepsis.” Various causative organisms and septic conditions are listed under the entry.
Example: A 39-year-old woman is admitted with high fever, malaise, and myalgias. Blood cultures and urine cultures taken on admission are positive for E. coli. The patient is diagnosed with septicemia and UTI due to E. coli.
A41.51 Sepsis due to Escherichia coli [E. coli]
N39.0

https://www.aapc.com/blog/31689-sepsis-and-sirs-code-it-right-in-icd-10-cm/

I would agree with that, however this code first note at the A41 category says that one of the listed codes must go first.
Code First
postprocedural sepsis (T81.4)
sepsis during labor (O75.3)
sepsis following abortion, ectopic or molar pregnancy (O03-O07, O08.0)
sepsis following immunization (T88.0)
sepsis following infusion, transfusion or therapeutic injection (T80.2-)

This note tells us one of the listed codes must go first listed. Otherwise I would have agreed with you. That was the way we did it with ICD-9. But things change with ICD-10 CM.

 

[kcarlyle]

The "Code First" items listed are complication codes. Wouldn't that make sense that if sepsis was due to a complication then the complication code would be coded 1st? Is the "Code First" note all inclusive or is it giving direction for when sepsis is with a complication? The AAPC article does pertain to ICD 10 and is from the August 2015 Healthcare Business Monthly.

 

[mitchellde]

It is not an open ended code first note , like the ones that say code first such as. So i interpret that to mean your first listed dx code must be one of the ones listed. I realize it is a current article but that does not mean it wa well researched.

 

[Fahad.Ogagang@MiraMedGS.com]

1st coded

Sepsis should be coded first if that condition is POA Y, the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis, with this said the Sepsis code should be principal diagnosis followed by U.T.I.
I agree that the code should be A41.59 for sepsis gram neg followed by B96.4 for specificity of the organism involved plus N39.0 for the localized infection.
if sepsis is not present on admission the U.T.I. should be sequence first- I.P. coding
systemic first followed by localized infection- O.P. Coding

 

[zmashchak]

What I Actually Coded

I do not remember if the sepsis was POA or not for the patient in question. I used three codes, and I believe I sequenced them this way: A41.59 (the sepsis code), N39.0 (the UTI code) and then B96.4 (the Proteus Mirabilis code). I hope this helps those who are curious about what I actually ended up doing for this situation. Have fun with any further discussion!

 

[mitchellde]

I do not remember if the sepsis was POA or not for the patient in question. I used three codes, and I believe I sequenced them this way: A41.59 (the sepsis code), N39.0 (the UTI code) and then B96.4 (the Proteus Mirabilis code). I hope this helps those who are curious about what I actually ended up doing for this situation. Have fun with any further discussion!

All A41 codes are secondary only allowed. They all state sepsis due to.... Sepsis is not an organism it is a response to an infection due to an organsim.. The A41 codes are equivalent to the ICD-9 codes for sepsis caused by non infections condition, such as trauma. These codes were also secondary only allowed they were just 995 codes.
The guidelines state:
(a) Sepsis
For a diagnosis of sepsis, assign the appropriate code for the underlying systemic infection. If the type of infection or causal organism is not further specified, assign code A41.9, Sepsis, unspecified organism
In the case posted the underlying infection is the UTI not sepsis, and the organism is the proteus mirabilis.
Even R65.1 has an excludes 1 note for sepsis- code to the infection. Again the infection is the UTI not sepsis due to.
We must learn to read all applicable notes. And not let ICD-9 logic get in the way.

 

[Fahad.Ogagang@MiraMedGS.com]

sepsis

it is true that if the sepsis is due to non-infectious process and the reason for the admission is the non-infectious disease, the non-infectious such as trauma should become the principal diagnosis but if the sepsis is present on admission and meet the criteria for principal diagnosis the sepsis should be coded first.
With regards to sepsis due to an underlying infectious condition and they are both present on admission the systemic infection should be coded first, take note on the word SYSTEMIC infection, U.T.I. is not a SYSTEMIC infection but a LOCALIZED infection of the URINARY TRACT, in the guidelines it is stated to code first the underlying systemic infection this means to code the appropriate sepsis code, analyzed the condition of the patient, even if U.T.I. is the cause of sepsis, sepsis is a severe INFECTION and should be the focus of the treatment, patients are not typically admitted to the hospital for a U.T.I.. Just wanted to ask “Does a UTI normally require an inpatient admission?”

NOT: this only applies if sepsis is PRESENT ON ADMISSION.

 

[mitchellde]

Yes a UTI can be the reason for inpatient status.

How are going to explain the code first note for the A41 and A40 codes? You cannot ignor it, and you cannot bypass it.
Sepsis is not the infection. It is the bodies response to the infection which is caused by an opportunistic organism. Such as septicemia. The infection are things like pneumonia, or kidney infection, or yes even a UTI. Sepsis is caused by the immune response which is triggered by the infection or in the case of non infectious, trauma.
Coding this is just different in ICD-10 CM. there is no 995.91 code for sepsis due to infection anymore.

 

[Fahad.Ogagang@MiraMedGS.com]

sepsis infection

code first of sepsis
Code first postprocedural sepsis (T81.4)
sepsis during labor (O75.3)
sepsis following abortion, ectopic or molar pregnancy (O03-O07, O08.0)
sepsis following immunization (T88.0)
sepsis following infusion, transfusion or therapeutic injection (T80.2-)
this are not related to this situation, it is a common knowledge that O codes should be coded first and complication codes are also coded first. we are talking about localized and systemic infection here.

Sepsis is a Systemic Infection, if sepsis is not an infection then how could you explain SEPSIS PROTEUS MIRABILIS, STREPTOCOCCAL SEPSIS
sepsis actinomycotic
sepsis anthrax
sepsis candidal
sepsis Erysipelothrix
sepsis extraintestinal yersiniosis
sepsis gonococcal
sepsis herpesviral
sepsis listerial
sepsis melioidosis
sepsis meningococcal
sepsis plague
sepsis tularemia
SEPSIS is a severe infection of the blood that is why most of the time the patient needs a blood culture in order properly to diagnose sepsis, signs of sepsis includes WBC of 12,000 above, septicemia has the same code with sepsis

 

[Fahad.Ogagang@MiraMedGS.com]

coding clinic

Coding Clinic, Third Quarter 2011 Page:15
Coding Clinic, Third Quarter 2012 Page: 11
there are lots of coding clinics that indicate sepsis as a systemic infection and should be coded first if present on admission and the localized infection such as U.T.I. as a secondary diagnosis

 

[mitchellde]

The coding clinic articles you reference were written for ICD-9, but even still at no time did they stat to cod sepsis which was 995,91 or 995.92 first listed. They do state to code the infection first. In ICD-9 these codes were indicated as secondary only codes and the underlying infection had to be coded first and if the organism was not known then use the organism of septicemia unspecified. But the condition of sepsis should always be a secondary code, with the underlying infection first listed.
Go look up sepsis and see what the medical books define sepsis as. Here is one statement from Netters
Sepsis is a life-threatening condition that arises when the body's response to infection injures its own tissues and organs.
See sepsis is not the infection, sepsis is the bodies response to infection or injury which causes the tissue to breakdown and can lead to death.
The code first note listed under the codes is not an optional issue. These are coding conventions that must be followed. As I said before some are open ended and state "code first the underlying condition such as", indicating an underlying condition must go first and it code be any of the ones listed or it could be something else along the same line. Categories A40 and A41 do not have this open ended type of note. It states to "code first" and gives you definitive list of choices. The coder does not get the opportunity to decide to use the codes and ignore this note when you feel it does not fit. A40 and A41 codes, like 995.91 and 995.92 codes are secondary only codes.
Again this is ICD-10 CM and things are slightly different. But the rules of diseases and disease processes have not changed. Sepsis is not a systemic infection, it is a systemic response to infection. This is a very different issue.

 

[mitchellde]

code first of sepsis
Code first postprocedural sepsis (T81.4)
sepsis during labor (O75.3)
sepsis following abortion, ectopic or molar pregnancy (O03-O07, O08.0)
sepsis following immunization (T88.0)
sepsis following infusion, transfusion or therapeutic injection (T80.2-)
this are not related to this situation, it is a common knowledge that O codes should be coded first and complication codes are also coded first. we are talking about localized and systemic infection here.

Sepsis is a Systemic Infection, if sepsis is not an infection then how could you explain SEPSIS PROTEUS MIRABILIS, STREPTOCOCCAL SEPSIS
sepsis actinomycotic
sepsis anthrax
sepsis candidal
sepsis Erysipelothrix
sepsis extraintestinal yersiniosis
sepsis gonococcal
sepsis herpesviral
sepsis listerial
sepsis melioidosis
sepsis meningococcal
sepsis plague
sepsis tularemia
SEPSIS is a severe infection of the blood that is why most of the time the patient needs a blood culture in order properly to diagnose sepsis, signs of sepsis includes WBC of 12,000 above, septicemia has the same code with sepsis

These are not indication that sepsis is the infection. These indicate that the organism of xyz caused the septic response. Septicemia does not have the same code, it says sepsis due to septicemia.
The guidelines state:
For a diagnosis of sepsis, assign the appropriate code for the underlying systemic infection.
They are not saying use the code for sepsis they are saying use the code for the underlying systemic infection. Sepsis and septicemia are not interchangeable terms.
If the code first terms are not related to the scenario then you cannot use this category of codes.

 

[Fahad.Ogagang@MiraMedGS.com]

infection

the coding clinic say that sepsis is a systemic infection, I am not referring to the code but the word systemic infection, coding clinics unless change or updated can be apply to both ICD 9 and 10. if the body reacts to an infection it means that you are infected. Tonsillitis, Bronchitis, Cystitis is a reaction to infection and consider as an infective disease. If the body has response systemically to an infective agent means that your body has a systemic infection and that is sepsis.

Septicemia A41.9
Sepsis (generalized) (unspecified organism) A41.9
same code

AAPC ARTICLE
A 39-year-old woman is admitted with high fever, malaise, and myalgias. Blood cultures and urine cultures taken on admission are positive for E. coli. The patient is diagnosed with septicemia and UTI due to E. coli.
A41.51 Sepsis due to Escherichia coli [E. coli]
N39.0

Sepsis (Blood Infection) and Septic Shock according to http://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection?page=2
The term sepsis is often used interchangeably with septicemia, a serious, life-threatening infection that gets worse very quickly and is often fatal. according to http://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection
How Is Sepsis Treated?
Sepsis can quickly progress to septic shock and death if it is left untreated. Doctors use a number of medications to treat sepsis, including:
antibiotics via IV to fight infection- doctors treat sepsis by using antibiotic- http://www.healthline.com/health/sepsis#Diagnosis6
Sepsis (Blood Infection)- http://www.emedicinehealth.com/sepsis_blood_infection/article_em.htm
Sepsis (blood poisoning) can be a deadly infection-http://www.medicinenet.com/sepsis/article.htm

AAPC Article

Coding tips: Per the guidelines, if the patient is admitted with a localized infection and sepsis or severe sepsis, the code for the systemic infection should be assigned first, followed by a code for the localized infection. If the patient is admitted with a localized infection and the patient does not develop sepsis or severe sepsis until after the admission, the localized infection is coded first, followed by the appropriate codes for sepsis or severe sepsis.

Sepsis almost always begins with localized infection. The source of the systemic infection is typically pneumonia, urinary tract infection (UTI), cellulitis, or a complication of a surgery or device. When these infections are contained, they are self-limiting, but sepsis can occur when the infectious organisms enter the blood stream. For this reason, it’s important that localized infections are identified and treated promptly.- if you analyze this you'll come up with the idea that sepsis is the systemic infection

 

[Fahad.Ogagang@MiraMedGS.com]

code first

what you need to know about code first
coding clinic states that you can only use code first in sepsis if those conditions are present during hospital stay

 

[mitchellde]

the coding clinic say that sepsis is a systemic infection, I am not referring to the code but the word systemic infection, coding clinics unless change or updated can be apply to both ICD 9 and 10. if the body reacts to an infection it means that you are infected. Tonsillitis, Bronchitis, Cystitis is a reaction to infection and consider as an infective disease. If the body has response systemically to an infective agent means that your body has a systemic infection and that is sepsis.

Septicemia A41.9
Sepsis (generalized) (unspecified organism) A41.9
same code

AAPC ARTICLE
A 39-year-old woman is admitted with high fever, malaise, and myalgias. Blood cultures and urine cultures taken on admission are positive for E. coli. The patient is diagnosed with septicemia and UTI due to E. coli.
A41.51 Sepsis due to Escherichia coli [E. coli]
N39.0

Sepsis (Blood Infection) and Septic Shock according to http://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection?page=2
The term sepsis is often used interchangeably with septicemia, a serious, life-threatening infection that gets worse very quickly and is often fatal. according to http://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection
How Is Sepsis Treated?
Sepsis can quickly progress to septic shock and death if it is left untreated. Doctors use a number of medications to treat sepsis, including:
antibiotics via IV to fight infection- doctors treat sepsis by using antibiotic- http://www.healthline.com/health/sepsis#Diagnosis6
Sepsis (Blood Infection)- http://www.emedicinehealth.com/sepsis_blood_infection/article_em.htm
Sepsis (blood poisoning) can be a deadly infection-http://www.medicinenet.com/sepsis/article.htm

AAPC Article

Coding tips: Per the guidelines, if the patient is admitted with a localized infection and sepsis or severe sepsis, the code for the systemic infection should be assigned first, followed by a code for the localized infection. If the patient is admitted with a localized infection and the patient does not develop sepsis or severe sepsis until after the admission, the localized infection is coded first, followed by the appropriate codes for sepsis or severe sepsis.

Sepsis almost always begins with localized infection. The source of the systemic infection is typically pneumonia, urinary tract infection (UTI), cellulitis, or a complication of a surgery or device. When these infections are contained, they are self-limiting, but sepsis can occur when the infectious organisms enter the blood stream. For this reason, it’s important that localized infections are identified and treated promptly.- if you analyze this you'll come up with the idea that sepsis is the systemic infection

No you do not come up with the idea that sepsis is the systemic infection. It clearly states that sepsis is the response to the infection.
I would challenge the coding clinics on the code first interpretation. The coding guidelines which are developed by the same entity that develops the code set states:
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD- 10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
At no time do they state to code first if you want to. There are however some codes that have notes that do state to code first if applicable. Old coding clinics do not necessarily apply to this new code set.
Sepsis is not the infection. I am sorry but I will disagree every time. Everything in the code book and the guidelines is trying to tell you this. It is a systemic response to an infection. Everything in the books on disease processes is telling you this. Do not get the terms organism and infection confused. Septicemia and sepsis are not interchangeable terms, this has been stated numerous times, by the CDC and the AMA.
From the article you referenced:
Bacterial infections are the most common cause of sepsis. However, sepsis can also be caused by other infections. The infection can begin anywhere bacteria or other infectious agents can enter the body. It can result from something as seemingly harmless as a scraped knee or nicked cuticle or from a more serious medical problem such as appendicitis, pneumonia, meningitis, or a urinary tract infection.
This should clearly show that the sepsis is not the infection, it is caused by the infection. The bodies response to the infection, but it is not the infection. Sepsis is due to the presences of the infection, go back to basic coding rules, if you have an underlying condition that is the cause of the current condition, then code the underlying condition first. So the underlying condition is the infection. The infection is the UTI.

 

[rbandaru]

Need to code cerumen impacted as it was mentioned

We need to code for A41.59 ,N39.0 no need to code separate for Proteus Mirabilis B96.4.

 

[mitchellde]

No you code the N39.0 with the B96.4. The A41 code cannot be a first listed code.

 

[Fahad.Ogagang@MiraMedGS.com]

read this article, for you to know that sepsis is coded first

https://www.aapc.com/blog/31689-sepsis-and-sirs-code-it-right-in-icd-10-cm/
http://www.hcpro.com/content.cfm?content_id=298503

 

[Fahad.Ogagang@MiraMedGS.com]

Sepsis (generalized) (unspecified organism) A41.9
actinomycotic A42.7
adrenal hemorrhage syndrome (meningococcal) A39.1
anaerobic A41.4
Bacillus anthracis A22.7
Brucella (see also Brucellosis) A23.9
candidal B37.7
cryptogenic A41.9
Enterococcus A41.81
Erysipelothrix (rhusiopathiae) (erysipeloid) A26.7
Escherichia coli (E. coli) A41.5
extraintestinal yersiniosis A28.2gangrenous A41.9
gonococcal A54.86
Gram-negative (organism) A41.5
etc..

these are the code for sepsis
the Systemic Infection is The organism that cause the sepsis whether if its specified or not, the underlying systemic infection is the
(due to) (in) actinomycotic
(due to) (in) anthrax
(due to) (in) candidal
(due to) (in) Erysipelothrix
(due to) (in) extraintestinal yersiniosis
etc..
which has a combination code with sepsis that's why sepsis is coded first.

Sepsis Proteus Maribilis code is Gram-negative Sepsis A41.59
the systemic infection is the Gram-negative organism and because it is already combine with sepsis A41.59 should be coded first followed by the localized infection U.T.I.

upon asking my superior I now agree with you that sepsis is not the infection itself but the organism involve, sepsis is the principal diagnosis in this case because the the code for sepsis is combined with the systemic infection.

 

[mitchellde]

Sepsis was combined with the infection which is the UTI then the organism. In ICD-9 the code for sepsis due to infection was 995.91 which was never allowed first listed you had to code the infection first listed. The infection required an organism. That is why the guidelines stated that if an organism was not documented you used the septicemia code. Now for ICD-10 the codes are all very different and there is no code for sepsis due to infection. The guidelines indicate to code the underlying infection and if the organism is not document use the A41.9. In this case the under lying infection is the UTI, the organism is specified as the proteus, so there is no A41 code to add. Basic coding guidelines, when the documentation indicates that an underlying condition is responsible for the current condition, you code the underlying condition first. So code the UTI first. The UTI is the reason for the sepsis. The UTI was caused by the presence of the proteus organism.
Thank your supervisor for me.

 

[Fahad.Ogagang@MiraMedGS.com]

sepsis

UTI is not to be coded first, if you can provide any documentation that UTI should be coded first instead of Sepsis then I might agree with you, considering that it should be POA
it is said to code the underlying systemic infection, UTI is not a systemic infection, avoid removing the word systemic, UTI is a localized infection, it is an infection of the urinary tract. bacteria which is the proteus Mirabilis infected the patient body system that why sepsis occurs. it is clear that it said "if the organism is not document code A41.9 Sepsis, unspecified organism" in this case the organism is identified that is why it is appropriate to code A41.59.

you should learn to accept your mistakes too...

 

[mitchellde]

A41 is not an infection code category and that is why it is secondary code category. Sorry but this is not a mistake it is following all of the or react coding guidelines and disease process rules.

 

[Fahad.Ogagang@MiraMedGS.com]

A41 is not an infection code category

Chapter 1
Certain infectious and parasitic diseases (A00-B99)
Includes:
diseases generally recognized as communicable or transmissible

This chapter contains the following blocks:
A00-A09 Intestinal infectious diseases
A15-A19 Tuberculosis
A20-A28 Certain zoonotic bacterial diseases
A30-A49 Other bacterial diseases

ICD-10-CM TABULAR LIST of DISEASES and INJURIES
Table of Contents
1 Certain infectious and parasitic diseases (A00-B99)

well it is in the infection category,, sorry

 

[mitchellde]

It is in the subsection for bacterial diseases. It is a condition due the the presence of a bacteria . It use to be called blood poisoning. This is the last time I am going to respond to this post. If you want to debate it more you can try to PM or email me.

 

[kcarlyle]

Sepsis is by far the most challenging diagnosis coding I've come across! The discussion has been great! I went to AAPC HealthCon 2015 and attended a session on Sepsis. The presenter included ICD9 and ICD10 examples. This is from the handout -

If the documentation says:Sepsis due to a specific organism

•ICD-10-CM
•A40 –A41.89
•Local infection

•With severe sepsis or OD
•A40 –A41.89
•R65.2-
•Local infection
•OD


•ICD-9-CM
•038.X (specific organism)
•995.91
•Local infection

•With severe sepsis or OD
•038.X (specific organism)
•995.92
•Local infection
•OD

 

[Fahad.Ogagang@MiraMedGS.com]

yes

at least others agree to me that sepsis should be coded first, healthcon and the one who posted this coded sepsis as the principal diagnosis

 

[Fahad.Ogagang@MiraMedGS.com]

ICD 9 Coding Clinic

Coding Clinic, Fourth Quarter 2015: Page 20

ICD 9 coding clinic is still applicable in ICD 10 for as long as there is nothing new published in Coding Clinic for ICD-10-CM and ICD-10-PCS to replace it, the advice would stand.

 

[zmashchak]

Please Help With Another Similar Situation!

I have another similar situation to my first situation, although there are a few differences. Below are the relevant details of my second situation.

1. The patient's condition was NOT present on admission, and the patient is an inpatient.
2. The patient's "infection" is bacteremia NOT a UTI.
3. Again, the patient has sepsis.
4. Again, the "organism" is proteus mirabilis.

I have read all the preceding discussion, but it does not seem to contain what I need for this second situation. Thank you in advance for any help!

 

[Fahad.Ogagang@MiraMedGS.com]

I have another similar situation to my first situation, although there are a few differences. Below are the relevant details of my second situation.

1. The patient's condition was NOT present on admission, and the patient is an inpatient.
2. The patient's "infection" is bacteremia NOT a UTI.
3. Again, the patient has sepsis.
4. Again, the "organism" is proteus mirabilis.

I have read all the preceding discussion, but it does not seem to contain what I need for this second situation. Thank you in advance for any help!

if sepsis is not present on admission then code the reason for the patient admission.
If patient has both sepsis and bacteremia then code sepsis only, sepsis has an exclude note for bacteremia and bacteremia will ask you to see sepsis if the patient has sepsis.
if the provider documents the relationship between sepsis and proteus mirabilis then code A41.4
under
-sepsis A41.9
--Gram negative (organism) A41.5
----anaerobic A41.4

 

[zmashchak]

Yes. Thank you!

if sepsis is not present on admission then code the reason for the patient admission.
If patient has both sepsis and bacteremia then code sepsis only, sepsis has an exclude note for bacteremia and bacteremia will ask you to see sepsis if the patient has sepsis.
if the provider documents the relationship between sepsis and proteus mirabilis then code A41.4
under
-sepsis A41.9
--Gram negative (organism) A41.5
----anaerobic A41.4

Thank you so much for your help! I was thinking along these lines myself. Since my provider documented a relationship between the sepsis and Proteus Mirabilis, I will code the sepsis first. I have learned that Proteus Mirabilis is actually an aerobic organism rather than an anaerobic organism. Thus, the code is actually A41.59. Thank you again for your help.

 

[Fahad.Ogagang@MiraMedGS.com]

Your welcome and correct me if I am wrong but wiki told me that Proteus mirabilis is a Gram-negative, facultatively anaerobic, rod-shaped bacterium, got me confuse when you said that it's aerobic. Also if the patient reason for admission is because of the infection then sepsis is POA because of the combination code of sepsis and the organism involved.

 

[zmashchak]

Further Explanation

Your welcome and correct me if I am wrong but wiki told me that Proteus mirabilis is a Gram-negative, facultatively anaerobic, rod-shaped bacterium, got me confuse when you said that it's aerobic. Also if the patient reason for admission is because of the infection then sepsis is POA because of the combination code of sepsis and the organism involved.

Yes, I can see where you would be confused. I have a relative who is a doctor, and she said that Proteus Mirabilis is aerobic not anaerobic. I was also told by my provider that the organism is aerobic not anaerobic. Wikipedia is not always correct. Also, I checked again and the reason for the patient's original reason for admission was not related to the infection organism or the sepsis. If it had been, then yes, it would make sense to consider the sepsis as POA. I hope this helps you as you have helped me!

 

[Fahad.Ogagang@MiraMedGS.com]

Yes, I can see where you would be confused. I have a relative who is a doctor, and she said that Proteus Mirabilis is aerobic not anaerobic. I was also told by my provider that the organism is aerobic not anaerobic. Wikipedia is not always correct. Also, I checked again and the reason for the patient's original reason for admission was not related to the infection organism or the sepsis. If it had been, then yes, it would make sense to consider the sepsis as POA. I hope this helps you as you have helped me!

Thanks for clearing up things to me, Just want to add that if sepsis is not present on admission and there are no indicators that sepsis might be present before the admission then sepsis can't become the principal diagnosis as the UHDDS states that principal diagnosis should be chiefly responsible for occasioning the admission of the patient to the hospital for care. in this case the reason for admission was from a different condition and not because of infection.

 

[trinalankford]

I would agree with that, however this code first note at the A41 category says that one of the listed codes must go first.
Code First
postprocedural sepsis (T81.4)
sepsis during labor (O75.3)
sepsis following abortion, ectopic or molar pregnancy (O03-O07, O08.0)
sepsis following immunization (T88.0)
sepsis following infusion, transfusion or therapeutic injection (T80.2-)

This note tells us one of the listed codes must go first listed. Otherwise I would have agreed with you. That was the way we did it with ICD-9. But things change with ICD-10 CM.

Nobody is probably paying attention to this thread at this late date, but I am going to write, anyway.

Yes, there is a "Code First" note at A41; HOWEVER, read through those conditions. That is a very select group of patients who will use one of those diagnoses:

T81.4 Postprocedural sepsis
O75.3 Sepsis during labor
O03-O07, O08.0 Sepsis following abortion, ectopic or molar pregnancy
T88.0 Sepsis following immunization
T80.2- Sepsis following infusion, transfusion or therapeutic injection

I know that NONE of the patients I've coded sepsis on in recent months have had ANY of those diagnosis codes.

I believe that the intent of that "Code First" note is that IF THE PATIENT HAS ANY OF THOSE CONDITIONS, code that condition FIRST before A41.0. In the absence of ANY OF THOSE CONDITIONS, you must use the A41 code before your infection code. Not every patient will have sepsis relating to a procedure, or labor, or pregnancy, or immunization, or any infusion. That defines all of the listed conditions. In the ABSENCE of one of those conditions, that would include your patient with a Proteus UTI leading to sepsis (none of the above apply). That would include the patient with pyelonephritis leading to sepsis (none of the above apply). That would be the case with any patient who does NOT have one of those very selective diagnoses listed above, because that code would be primary.

I'm reading it as in the absence of any of those conditions, your A41 code will go before your infection code.