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| =={{g|Guideline}}== | | =={{g|Guideline}}== |
| * Positive (+ ve) blood cultures | | * Positive (+ ve) blood cultures |
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| | * Note: Septicemia/Bacteremia/Fungemia may be the working DX that the physician is treating but we cannot use the term septicemia unless there are positive blood cultures. If a source is not identified by cultures then use fever NYD. A septic patient just means that they likely have an infection somewhere, it does '''not'''mean they have septicemia. Again, the term "septicemia" is only used if the patient has a pathogen isolated in the blood! |
| * Septicemia/Bacteremia/Fungemia is the working DX that the physician is treating | |
| ** no blood cultures was sent, code as septicemia (46)– no blood culture sent (92)
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| ** a blood culture was sent, code as septicemia (46) - '''and'''
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| *** (a pathogen subcode) '''OR'''
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| *** negative blood culture (64) '''OR'''
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| *** Unknown pathogen(68), if you are not clear which bug is causing the infection
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| ==Examples==
| | *** Unknown pathogen(68)only used for septicemia if the patient was transferred from a hospital where positive blood cultures were found but it is unclear which organism it was because it was not included in the documentation sent with the patient. |
| ''Physicians in general, follow their own varied and inconsistent guidelines when documenting the diagnosis of septicemia, severe sepsis or shock therefore it can be a challenge for data collectors particularly when the DX is septic shock or severe sepsis.'' The examples here provide a guideline for collectors on how to code.
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| ===Patient admitted with urosepsis, treated, affecting blood culture results===
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| *When a patient has been admitted with '''urosepsis''' as an example, and has been determined by the physician to be '''septicemic''' and has received '''antibiotics before the blood cultures''' have been drawn and thereby affecting the results showing negative culture. Coding criteria for septicemia on page 10 of diagnosis code book is defined as "positive blood cultures". | |
| ====Instructions====
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| #septicemia (46) – subcode (65) –negative culture (if a blood culture was sent & no bugs) '''AND'''
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| #[[urosepsis]] (cystitis, bladder infection)(51) – subcode (65)- negative culture (if a urine culture was sent & no bugs) or subcode (92) –if no urine culture sent.''[[User:TOstryzniuk|TOstryzniuk]] 10:20, 23 December 2008 (CST)
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| ===Physician Recording Sepsis without +ve blood culture ===
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| *code the physician's working DX .Usually signs of infection are present ie.fever, high WBC
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| * If the chart notes are unclear you can ask the physician.
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| * If the physician is calling it septicemia,the cultures are negative,and there are antibiotics ordered we code as septicemia subcode “negative culture”
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| * don't use fever NYD for patients with fever related to infections
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| ====Instructions====
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| If the physician's diagnosis is urosepsis and the blood culture is negative but the urine is positive we code ''' both''':
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| #''septicemia (46) – subcode (65) –negative culture (blood culture was sent & no bugs ID'd).
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| #''urosepsis (51) – subcode (XX) type of bug ID’d''
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| ===Physician recording severe sepsis or septic shock when not all criteria are met===
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| "I don't expect a collector to make the DX or debating with the physician about it therefore code the physician's working DX for this problem. Of course if chart notes are really not clear you can ask the physician."(Trish)
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| ====Instructions ====
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| If sepsis is the working DX that the physician is treating then this is what the collector must code as the DX.
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| ===Does this mean the definition has changed?===
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| Change to these instructions raised the concern that it conflicts with pervious instructions from the collection guide. Trish stated that there was no change. Instead the change to this article was meant to clarify that "''Negative or inconclusive blood cultures do not preclude a diagnosis of septicemia in patients with clinical evidence of the condition.''"17:12, 7 January 2009 (CST)--
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| There are concerns that this caveat will result in a lack of vigilance to only collect true septicemias rather than taking the doctor's word for it.
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| The change in these rules might result in over-reporting, but for research purposes over-reporting is much more easily corrected than under-reporting, since a patient can easily be excluded from research if chart review shows they do not match criteria.
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| * This site will need a revision if we decide to go with Dr. Kumar's recommendations at the June 6,2012 staff meeting.
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| | ===Physician Recording Septicemia without +ve blood culture === |
| | *If this happens it is best to ask the physician about this. Usually they mean septic not septicemia because they are still unsure of the source. |
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