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
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
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.