Template:ICD10 Guideline Sepsis: Difference between revisions

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~~'''Excludes~~: ~~Only code one of~~ [[~~Shock~~, ~~septic~~]] or ~~[[Severe sepsis]], do not code them together. '''~~

*As of January 2019, we are still using the SEPSIS-2 approach to diagnosis. Sometime in 2019 we expect to switch over to the SEPSIS-3 definition. SEPSIS-2 delineates 3 subtypes of sepsis:

~~Sepsis comes in two subcategories:~~

**[[Sepsis (SIRS due to infection, without acute organ failure)]] -- defined as SIRS due to a known or presumed infection

*[[Severe sepsis~~|Sepsis~~]] ~~is life-threatening organ dysfunction caused by a dysregulated host response to infection~~ -- ~~NOTE this was the 2001 definition of "severe~~ sepsis"

**[[Severe sepsis]] -- defined as sepsis PLUS one or more acute organ failures

*[[Shock, septic~~|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~~

**[[Shock, septic]] -- defined as severe sepsis where an acute organ failure is the cardiovascular system (i.e. shock, hypoperfusion)

The ~~cause~~ of the ~~sepsis can~~ be ~~proven infection or '''presumed''' infection. '''Positive cultures are ''~~not~~'' required.'''~~

*Although a person can evolve over time from one to a more advanced subtype, at any one time you should only code ONE of these 3 entities

*REGARDING IDENTIFYING THE ORGANISM RESPONSIBLE:

**Until 2019, the rule was that you only identify the responsible organism if it was present in blood culture. THIS RULE HAS CHANGED AS OF 1/1/2019 -- because in fact the majority of even septic shock cases never grow anything from the blood and most derive from localized infections (pneumonia, UTI, etc)

**The rule now is that you make all efforts to identify the specific organism, even if the blood cultures never grow anything

**e.g. Patient has severe sepsis with the acute organ failure being acute renal failure due to ATN --- and it's felt to be due to a pseudomonas pneumonia. So in this case the pseudomonas is the bug that should be combined with the pneumonia AND also with the severe sepsis.

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 cas the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is [[Bacteria, NOS]]

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 </noinclude>
-'''Excludes: Only code one of [[Shock, septic]] or [[Severe sepsis]], do not code them together. '''
+*As of January 2019, we are still using the SEPSIS-2 approach to diagnosis.  Sometime in 2019 we expect to switch over to the SEPSIS-3 definition.  SEPSIS-2 delineates 3 subtypes of sepsis:
-Sepsis comes in two subcategories:
+**[[Sepsis (SIRS due to infection, without acute organ failure)]] -- defined as SIRS due to a known or presumed infection
-*[[Severe sepsis|Sepsis]] is life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"
+**[[Severe sepsis]] -- defined as sepsis PLUS one or more acute organ failures
-*[[Shock, septic|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
+**[[Shock, septic]] -- defined as severe sepsis where an acute organ failure is the cardiovascular system (i.e. shock, hypoperfusion)
-The cause of the sepsis can be proven infection or '''presumed''' infection. '''Positive cultures are ''not'' required.'''
+*Although a person can evolve over time from one to a more advanced subtype, at any one time you should only code ONE of these 3 entities
+*REGARDING IDENTIFYING THE ORGANISM RESPONSIBLE:
+**Until 2019, the rule was that you only identify the responsible organism if it was present in blood culture.  THIS RULE HAS CHANGED AS OF 1/1/2019 -- because in fact the majority of even septic shock cases never grow anything from the blood and most derive from localized infections (pneumonia, UTI, etc)
+**The rule now is that you make all efforts to identify the specific organism, even if the blood cultures never grow anything
+**e.g. Patient has severe sepsis with the acute organ failure being acute renal failure due to ATN --- and it's felt to be due to a pseudomonas pneumonia.  So in this case the pseudomonas is the bug that should be combined with the pneumonia AND also with the severe sepsis.
+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 cas the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is [[Bacteria, NOS]]