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sepsis again

Melissa Posted Tue 22nd of January, 2013 14:57:24 PM

Here is the question Pt has uti with ecoli, and sepsis. According to the guidelines I should code a septicema code for example 038.49 then my sepsis then the uti then the ecoli. Is this correct? why wouldnt the ecoli code 041.49 replace the 038.49? Please dont quote a guideline with no explanation. I need one on one guidance with this one. Thank you

SuperCoder Answered Wed 23rd of January, 2013 10:23:01 AM

If UTI by E.Coli has led to Sepsis, then code as -- 599.0, 041.49, 995.91. No need to code 038.49 or 038.42 since yo are already coding the "underlying condition". The code 995.91 in tabular section of ICD book mentions "code first underlying condition".

599.0 should be the first code as "infection". The tabular section, at 599.0 suggests to "use additional code to identify organism...".

The ICD Guideliens section at the beginning of the book [I.C.1.b.1.(b)] says:

"The coding of SIRS, sepsis and severe sepsis requires a minimum of 2 codes: a code for the underlying cause (such as infection or trauma) and a code from subcategory 995.9 (SIRS).... (i) The code for the underlying cause (such as infection or trauma) must be sequenced before the code from subcategory 995.9 (SIRS).

See guidelines section related to SIRS for more options about ICD ranking based on diagnoses as POA (whether Sepsis was present as POA , or developed later as a result of another infection, or whether both the Sepsis and infection were observed as POA).

If "septicemia" is mentioned as cause of sepsis or present along with sepsis, then code 038.x first (4th digit based on causal factor of septicemia - unknown factor - 9 ; E.Coli - 038.42)

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