Template:ICD10 Guideline Sepsis: Difference between revisions

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**e.g. Patient with septic shock has an E.coli UTI and a pseudomonas pneumonia. The team is not certain which of those two bacteria is causing the septic shock, but of course is treating them both. In this case the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is [[Bacteria, NOS]] }}

=== ~~Coding of the~~ sepsis ~~diagnoses~~ ===

=== Combining a sepsis code with a specific infection code ===

*~~''Usually'' we say~~ that ~~related diagnoses should be combined with~~ the ~~same priority~~.

*Guidelines for such combination to include (this is a new rule, changed Feb 19, 2020):

*But ~~for a technical reason having to~~ do ~~with how we~~ combine ~~diagnoses~~, ~~this~~ is NOT ~~the case for the 3 sepsis diagnoses~~

**Combine if it is reasonably clear that the specific infection is the source of the sepsis episode. But if it is NOT clear then do not combine.

**DO combine it with the ~~bug~~, and if the ~~bug is resistant~~ with the ~~bug resistance code~~

***Clear example, so DO combine: Sepsis and the only evident infection is pneumonia

**~~But do NOT~~ combine it with the ~~infection thought~~ to be the cause of the sepsis --- e.g. ~~if it's believed~~ that the ~~pneumonia is~~ the ~~cause of~~ the sepsis, ~~code them both but do NOT combine them~~

***Unclear example, so do NOT combine: Sepsis with both pneumonia and a UTI.

***Clear example, so DO combine. Sepsis with pneumonia developing around the same time, and then 5 days later a UTI occurs. Here it’s appropriate to combine the sepsis + pneumonia but not with the UTI.

***Clear example, so DO combine: Sepsis with pneumonia and bacteremia, with the same bug isolated from the lungs and blood. Here it’s reasonable to conclude that all 3 are causally related and combine all 3, with the same bug as cause in all 3.

*Regarding identifying the bug responsible for sepsis -- this also can be unclear, here is some guidance:

**In the presence of bacteremia, with or without other infection(s) (e.g. pneumonia) ALL showing the same bug, consider that bug to be the agent for the sepsis

**Without bacteremia, with one or more other infections occurring around the same time that all have the same bug, consider that bug to be the agent for the sepsis

**With multiple infections occurring around the same time as the sepsis, having DIFFERENT bugs, the bug responsible for the sepsis is not clear (even if one of those infections is bacteremia it’s still not clear), so in this case choose [[Infectious organism, unknown]]. Allan has added to that Wiki page to clarify this.

=== Criteria for SIRS ===

@@ Line 37: / Line 37: @@
 **e.g. Patient with septic shock has an E.coli UTI and a pseudomonas pneumonia.  The team is not certain which of those two bacteria is causing the septic shock, but of course is treating them both.  In this case the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is [[Bacteria, NOS]] }}
-=== Coding of the sepsis diagnoses ===
+=== Combining a sepsis code with a specific infection code ===
-*''Usually'' we say that related diagnoses should be combined with the same priority.
+*Guidelines for such combination to include (this is a new rule, changed Feb 19, 2020):
-*But for a technical reason having to do with how we combine diagnoses, this is NOT the case for the 3 sepsis diagnoses
+**Combine if it is reasonably clear that the specific infection is the source of the sepsis episode.  But if it is NOT clear then do not combine.
-**DO combine it with the bug, and if the bug is resistant with the bug resistance code
+***Clear example, so DO combine:  Sepsis and the only evident infection is pneumonia
-**But do NOT combine it with the infection thought to be the cause of the sepsis --- e.g. if it's believed that the pneumonia is the cause of the sepsis, code them both but do NOT combine them
+***Unclear example, so do NOT combine:  Sepsis with both pneumonia and a UTI.
+***Clear example, so DO combine.  Sepsis with pneumonia developing around the same time, and then 5 days later a UTI occurs.  Here it’s appropriate to combine the sepsis + pneumonia but not with the UTI.
+***Clear example, so DO combine:  Sepsis with pneumonia and bacteremia, with the same bug isolated from the lungs and blood.  Here it’s reasonable to conclude that all 3 are causally related and combine all 3, with the same bug as cause in all 3.
+*Regarding identifying the bug responsible for sepsis -- this also can be unclear, here is some guidance:
+**In the presence of bacteremia, with or without other  infection(s) (e.g. pneumonia) ALL showing the same bug, consider that bug to be the agent for the sepsis
+**Without bacteremia, with one or more other infections occurring around the same time that all have the same bug, consider that bug to be the agent for the sepsis
+**With multiple infections occurring around the same time as the sepsis, having DIFFERENT bugs, the bug responsible for the sepsis is not clear (even if one of those infections is bacteremia it’s still not clear), so in this case choose [[Infectious organism, unknown]].  Allan has added to that Wiki page to clarify this.
 === Criteria for SIRS ===