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Melissa Posted Wed 24th of July, 2013 12:55:14 PM

I have a scenario where we seen the pt for cellulitis and abscess foot culture grew strep b (wound culture not in blood), sepsis on admission and newly dx diabets mellitus. In this case Sepsis was not the main reason we were called in. I was going to code 682.7, 041.02 (since not in blood) or do I go with 038.49? then the 995.91 and the newly dx DM 250.00?

SuperCoder Answered Fri 26th of July, 2013 14:49:24 PM


I have forwarded this query to my editor. She will reply soon.


SuperCoder Answered Tue 30th of July, 2013 11:27:51 AM

A diagnosis of septicemia cannot be assumed or ruled out on the basis of laboratory values alone. Negative or inconclusive blood cultures do not preclude the diagnosis of septicemia in patient with clinical evidence of the condition.

In almost 25 to 35 % of suspected sepsis cases, culture results are not positive for pathogens.

In case of any doubt, we should query the physician.

What I can infer from the presented scenario, that Sepsis was present on admission.

Understanding of disease process will add more clarity to the scenario.

Localized Infection ---> SIRS ---> Sepsis ---> Severe Sepsis ---> Septic Shock

Cellulitis is localized infection. This leads to SIRS. SIRS progresses sepsis,which leads to severe sepsis, which ultimately progresses to septic shock.

As I mentioned earlier, sometimes we may face a situation in which the blood sample do not show presence of pathogens.

I n such a situation, we will have to read the medical record very carefully and try to look for clinical indicators to establish the diagnosis of SIRS.

The clinical indicators of SIRS/ SEPSIS
Impaired organ perfusion (altered mental status, oliguria, and hypotension)
Reduced blood PH
Metabolic Acidosis
We can also look for clues in the physician documentation where he may document “septic appearing patient”

If patient is having 2 or more than 2 of the above mentioned indicators at the time of admission, we can query the physician for the diagnosis of sepsis.

In the presented scenario, what I feel the thing which is stopping you to code 038.X is the negative blood culture report. I agree but the condition ultimately progressed to sepsis. Septicemia is just the part of the disease process. Hence, we can report 038.49+995.91+250.00

It is just like a scenario in which a patient presented to the hospital with complaint of chest pain, and diagnosis of angina was established, so in this case we only report angina, as chest pain is integral to the disease process.

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