Septicemia/Bacteremia/Fungemia

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Bacteremia

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Category/Organ System:	Category: Septicemia (Bacteremia/Fungemia) (old)
Type:
Main Diagnosis:	46-00
Sub Diagnosis:	Critical Care and Medicine
Diagnosis Code:	Currently Collected
Comorbid Diagnosis:
Charlson Comorbid coding (pre ICD10):
Program:
Status:

Note: See also Septic Shock, Severe Sepsis

Definition

Septicemia is the presence of bacteria/fungus in the blood (bacteremia, fungemia).

Criteria

Positive (+ ve) blood cultures

• if the physician's diagnosis is septicemia but no blood cultures was sent, code as follows:
  • septicemia (46)– subcode (92) –no blood culture sent

• if the physician diagnosis is septicemia and a blood culture was sent, code as follows:
  • septicemia (46) - (a pathogen subcode) OR
  • septicemia (46) - subcode (64) - negative blood culture OR
  • septicemia (46) - subcode (68) - Unknown pathogen, if you are not clear which bug is causing the infection.
• TOstryzniuk 18:48, 23 December 2008 (CST)

Examples

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. TOstryzniuk 10:20, 23 December 2008 (CST)

Patient admitted with urosepsis, treated, affecting blood culture results

• 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

• 1.septicemia (46) – subcode (65) –negative culture (if a blood culture was sent & no bugs) AND
• 2.urosepsis(51) – subcode (65)- negative culture (if a urine culture was sent & no bugs) or subcode (92) –if no urine culture sent.TOstryzniuk 10:20, 23 December 2008 (CST)

Physician Recording Sepsis without +ve blood culture

"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) Physicians are recording the diagnosis of septicemia even when blood cultures are negative (negative cultures even with no antibiotics given pre blood cultures draw). Is capturing cystitis with a bug, if found, adequate and septicemia should not be coded, or use code septicemia and subcode as “culture negative” if physician is calling it septicemia? Do we code as septicemia subcode “negative culture”?

Instructions

• • • 1. septicemia (46) – subcode (65) –negative culture (blood culture was sent & no bugs ID'd). AND
    • 2.urosepsis (51) – subcode (XX) type of bug ID’d

TOstryzniuk 10:20, 23 December 2008 (CST)

Physician recording severe sepsis or septic shock when not all criteria are met

"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)

• A similar question in regards to the definitions for severe sepsis, and septic shock if applicable. We have seen people who NOT meet all the criteria, yet they are exhibiting signs of either severe sepsis, or septic shock, and that is what the Dr. has diagnosed and is treating..--JHutton 11:13, 25 June 2008 (CDT).

Instructions

If this is the working DX that the physician is treating then this is what the collector must code as the DX. TOstryzniuk10:20, 23 December 2008 (CST).

Discussion

I will try to summarize this discussion as it's becoming messy and fragmented. Ttenbergen 10:31, 8 January 2009 (CST)

• I moved SKiesman's comment re. Kidney Infection to a new article for that dx, Kidney infections/abcesses. The article only has a question in it at this time and needs more content. Ttenbergen 10:00, 8 January 2009 (CST)

Does this mean the definition has changed?

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."TOstryzniuk 17:12, 7 January 2009 (CST)-- 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. 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.

Further discussion of this?

• anything still unclear?

Concerns that people might miss this important change

One data collector was concerned that important changes like this might be missed if we rely on data collectors following the Recent Changes, and suggested email notification of important changes. Tina is worried that if there is notification of "important" changes, people will feel that it is not necessary to keep up to date with Recent Changes. Upon discussion with the data collector, Tina found out that the problem was really one of lack of understanding how to use the Recent Changes. If everyone could review and follow the instructions in My Preferences in the wiki, then clicking on "diff" or "# changes" for the changed article, rather than the link for the article, one will actually see a Summary of the changes rather than just the new version of the article. This makes reviewing Recent Changes much easier!

Further discussion of this?

• anything still unclear?