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Septic Shock

  1. Question Septic Shock
    Medical Coding Books
    When coding septic shock due to MRSA woth associated acute respiratory failure, how many codes are required?

  2. Default
    4 codes. A code for the MRSA septicemia, for the Acute Respiratory Failure, Septic Shock and Severe Sepsis.

  3. Default Septi Shock due to MRSA
    1) If the patient have acute organ dysfunction, the first code would be the infection. (038.12) MRSA Septicemia
    2)Then you would use additional code to specify organ dysfunction (518.81) Acute Respiratory failure and (785.52) Septic Shock
    3) Then you would use code (995.92) Severe Sepsis

    So this would be your sequence : 038.12, 518.81, 785.52, 995.92)
    Hope this helps,
    Last edited by TonyaMichelle; 11-17-2011 at 01:43 PM.

  4. #4
    North Central Florida
    I was looking for an answer to another coding Q and saw this post and couldn't resist as I code for the MICU, happen to love diagnosis coding, and see a lot of this...

    The instructions in ICD-9 CM Vol 1 (Tabular) under severe sepsis (w/acute organ syfunction) direct us to "code first underlying infection" (septicemia code which is different than the usual MRSA infection code 041.12) and "Use additional code to specify acute organ dysfunction, such as:..." (Listed under this is septic shock and acute resp. failure)

    Thus our sequence is the following for severe sepsis as our principle diagnosis:

    1. 038.12 (MRSA septicemia)
    2. 995.92 (severe sepsis)
    3. 785.52 (septic shock)
    4. 518.81 (acute respiratory failure)

    It doesn't really matter whether 3 and 4 are interchanged with each other although generally I put the septic shock immediately after severe sepsis as historically the tabular instructions (2010) instruct us to "Code first: systemic inflammatory response syndrome due to infectious process with organ dysfunction (995.92)"

    In the 2011 ICD-9 CM (from AAPC) it's rather confusing as it says "Use additional code, if applicable, to identify systemic inflammatory response syndrome due to infectious process with organ dysfunction (995.92)" - I believe this to be an error as the tip right after this states "code 785.52 should not be assigned without first assigning code 995.92" which is the correct sequence according to the ICD-9 CM 2011 (and past years) guidelines (please see Section 1, Chapter 1.b.2.a)

    Instructions can also be found in the guidelines in Chapter 1.b concerning sepsis as a secondary diagnosis as well as useful definitions and reference to other specific instructions (e.g. how to code newborn sepsis which uses different codes...)

    Hope this helps,

    Hannah Gasser, CPC
    Division of Pulmonary and Critical Care Medicine
    Univeristy of Florida
    Last edited by hannahgasser; 11-17-2011 at 12:42 PM.

  5. Default
    Thanks Hannah, I edited my answer to reflect code 038.12.

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