Bacteremia: Difference between revisions
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=== Bacteremia is '''not''' a blind replacement for old septicemia dx! === | === Bacteremia is '''not''' a blind replacement for old septicemia dx! === | ||
The word "septicemia" is and always has been confusing, if not completely meaningless. It has been used both to mean [[pathogens]] in the blood (which is [[bacteremia]] or [[Fungemia, NOS]]), to mean toxic products of bugs in the blood (such as LPS or endotoxin which cause some of the clinical manifestations of [[Severe sepsis]]/[[Shock, septic]]), and to mean [[sepsis]] or [[Shock, septic]]. So going forward we don't need or want a replacement for that vague entity "septicemia". | The word "septicemia" is and always has been confusing, if not completely meaningless. It has been used both to mean [[pathogens]] in the blood (which is [[bacteremia]] or [[Fungemia, NOS]]), to mean toxic products of bugs in the blood (such as LPS or endotoxin which cause some of the clinical manifestations of [[Severe sepsis]]/[[Shock, septic]]), and to mean [[sepsis]] or [[Shock, septic]]. So going forward we don't need or want a replacement for that vague entity "septicemia". | ||
{{ICD10 Guideline Symptoms not needed when cause known}} | {{ICD10 Guideline Signs Symptoms Test Results not needed when cause known}} | ||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
Revision as of 08:33, 24 January 2019
| ICD10 Diagnosis | |
| Dx: | Bacteremia |
| ICD10 code: | A49.9 |
| Pre-ICD10 counterpart: | Septicemia |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Neuro NOS |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- Bacteremia is a clearcut entity, which means bacteria circulating in the blood, and not due to contaminated blood culture. #Bacteremia is not a blind replacement for septicemia!
- Bacteremia is a lab finding, not a disease. If the patient has a known infection AND/OR Severe sepsis OR Shock, septic you MUST code those. This follows our general rule, code symptoms, signs and diagnostic abnormalities when the underlying cause is unknown. If that cause is known, then of course you must code the cause, and coding the abnormal finding is optional.
Bacteremia is not a blind replacement for old septicemia dx!
The word "septicemia" is and always has been confusing, if not completely meaningless. It has been used both to mean pathogens in the blood (which is bacteremia or Fungemia, NOS), to mean toxic products of bugs in the blood (such as LPS or endotoxin which cause some of the clinical manifestations of Severe sepsis/Shock, septic), and to mean sepsis or Shock, septic. So going forward we don't need or want a replacement for that vague entity "septicemia".
Symptom/Sign/Test Result not needed when cause known
- This code identifies a symptom or a sign, or an abnormal test result, not a disorder.
- So, you should code the cause of the symptom/sign/abnormal test, if known -- and if you do so, then also coding and combining the symptom/sign/abnormal test result to that cause is generally optional, but is guided by the following guidelines.
- Here are guidelines for whether or not to ALSO code the symptom/sign/abnormal test when you DO code the underlying cause:
- If it is a subjective symptom (e.g. pain) then coding it is optional
- When it is a physical exam finding (e.g. abdominal tenderness) then coding it is generally optional
- An exception is when the symptom/sign/abnormal testis so severe that all by itself it mandates hospitalization and/or a procedure -- a good example is a patient who has Wegener's granulomatosis is admitted due with Hemoptysis. Since hemoptysis is a physical finding that fits this description of "severe" it should be coded, and combined with Wegener's.
- When it is an abnormal laboratory finding which in and of itself has relevance (e.g. hyperkalemia, hypoalbuminemia) then USUALLY code it
- You don't need to code the abnormal lab finding is when it is actually a major component of the underlying cause --- example is when a person presents with an acute MI, there is no need to code the abnormal troponin as Abnormal blood chemistry NOS
- The trickiest of these guidelines is for abnormal radiologic tests
- When the abnormal test is fully explained by the underlying diagnosis/diagnoses (e.g. pneumonia as cause of abnormal chest imaging, or a skull fracture with an intracranial hemorrhage both identified by an abnormal head CT) then coding the abnormal imaging result is optional
- But remember there are some rare things for which the abnormal imaging result IS part of coding the entity, for example we code retroperitoneal hemorrhage by the combination of Hemorrhage, NOS and Retroperitoneal area, diagnostic imaging, abnormal
- Sometimes there may be multiple symptom/sign/test result that might or might NOT be related to each other by virtue of having the same underlying cause. Since in the absence of KNOWING that cause, such assumptions may well be incorrect, do NOT combine them together if you are not certain they actually have the same underlying cause.
Alternate ICD10s to consider coding instead or in addition
- Shock, septic
- Severe sepsis
- Sepsis (SIRS due to infection, without acute organ failure)
- Any infection that is the source of this bacteremia.
- Fungemia, NOS
- Bacterial infection, NOS
- Fever or fever of unknown origin (FUO)
Candidate Combined ICD10 codes
Infections
Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.
Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site
- This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
- As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
- And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
Attribution of infections
- Code the organism
- Others, as mentioned above.
Related CCI Codes
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check ICD10 Inf Infection req Pathogen must have one | CCMDB.accdb | implemented |
| Query Check Inf Pathogens must have Infection requiring pathogen or Potential Infection | CCMDB.accdb | implemented |
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