Template:ICD10 Guideline Sepsis
This template info about coding sepsis to keep it consistent across pages.
To use:
- {{ICD10 Guideline Sepsis}}
- 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 (SIRS due to infection, without acute organ failure) -- defined as SIRS due to a known or presumed infection
- Severe sepsis -- defined as sepsis PLUS one or more acute organ failures
- Shock, septic -- defined as severe sepsis where an acute organ failure is the cardiovascular system (i.e. shock, hypoperfusion)
- 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 severe sepsis (and with with the pneumonia, of course)
- 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 case the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is Bacteria, NOS
- A RULE ABOUT CODING any of the 3 sepsis subtypes
- Usually we as that related diagnoses be combined with the same priority.
- But for a technical reason having to do with how we combine diagnoses, this is NOT the case for the 3 sepsis diagnoses
- DO combine it with the bug, and if the bug is resistant with the bug resistance code
- But do NOT combine it with the infection thought to be the cause of the sepsis --- e.g. if it's believed that the pneumonia is the cause of the sepsis, do NOT combine those two.
| background about 2016 sepsis consensus |
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