Severe sepsis: Difference between revisions
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== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
*[[ | *[[Sepsis (SIRS due to infection, without acute organ failure)]] | ||
*[[Shock, septic]] | *[[Shock, septic]] | ||
*[[Puerperal (post-delivery) infections or sepsis]] | *[[Puerperal (post-delivery) infections or sepsis]] | ||
*[[Bacteremia, NOS]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc). | *[[Bacteremia, NOS]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc). | ||
{{ListICD10Category | categoryName = shock}} | |||
== Candidate [[Combined ICD10 codes]] == | == Candidate [[Combined ICD10 codes]] == | ||
Revision as of 01:53, 2017 November 14
| ICD10 Diagnosis | |
| Dx: | Severe sepsis |
| ICD10 code: | R65.1 |
| Pre-ICD10 counterpart: | Severe Sepsis |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Sepsis |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016). These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions we have just 2 subcategories:
- Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"
- Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone
- For these the cause is proven infection, OR presumed infection -- thus positive cultures are not required.
- Do not code this if the patient qualifies as having Shock, septic.
- The 2016 consensus group defined the ORGAN DYSFUNCTION as an acute CHANGE from patient's baseline total SOFA score by 2 or more points -- where the baseline SOFA score can be assumed to be 0 in patients not known to have preexisting organ dysfunction.
- Here is the SOFA scoring:
| Category | 0 | 1 | 2 | 3 | 4 |
| GCS | 15 | 13-14 | 10-12 | 6-9 | <6 |
| Platelets | >=150 | <150 | <100 | <50 | <20 |
| Serum bilirubin (uM) | <20 | 20-32 | 33-101 | 102-204 | >204 |
| Serum creatinine (uM) | <110 | 110-170 | 171-299 | 300-440 | >440 |
| Urine output (mL/day) | <500 | <200 | |||
| PaO2/FIO2 | >=400 | <400 | <300 | <200 | <100 |
| Cardiovascular | MAP>=70 | MAP<70 | see note A | see note B | see note C |
- Note A: dopamine < 5 OR any dose of dobutamine
- Note B: dopamine 5.1-15 OR epi<=0.1 OR norepi<=0.1
- Note C: dopamine >15 OR epi>0.1 OR norepi>0.1
- for these all doses are in microgram/kg/min
Alternate ICD10s to consider coding instead or in addition
- Sepsis (SIRS due to infection, without acute organ failure)
- Shock, septic
- Puerperal (post-delivery) infections or sepsis
- Bacteremia, NOS AND Fungemia, NOS -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).
| shock codes: |
Candidate Combined ICD10 codes
- Also code the causative infection.
Related Articles
Show all ICD10 Subcategories