Septicemia/Bacteremia/Fungemia

Dr Kumar We need your input on the following questions. Thanks kindly. Question';

1. 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".

TRISH REPLYTOstryzniuk 10:20, 23 December 2008 (CST)

• 1.septicemia(46) – subcode (65) –negative culture (if a blood culture was sent & no bugs)

• 2.urosepsis(51) – subcode (65)- negative culture (if a urine culture was sent & no bugs) or subcode (92) –if no urine culture sent

1. Also, physician are recording the diagnosis of septicemia even when blood cultures are negative (negative cultures even with no antibiotics given pre blood cultures draw).
2. b. How do you want these patients captured?? 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?

Trish Reply: TOstryzniuk 10:20, 23 December 2008 (CST) *1. septicaemia(46) – subcode (65) –negative culture (blood culture was sent & no bugs)

• 2.urosepsis(51) – subcode (XX) type of bug ID’d

1. b.If physician records the diagnosis of septicemia and that is their working diagnosis without a positive culture, do we code as septicemia subcode “negative culture”?

Trish Reply:TOstryzniuk 10:20, 23 December 2008 (CST) *1.septicemia – subcode (65) –negative culture (if blood culture was sent & no bugs ID’d).

• • OR
• septicemia – subcode (92) –no culture sent (if no blood culture was sent).

1. 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)..--JHutton 11:13, 25 June 2008 (CDT)TOstryzniuk 11:59, 25 June 2008 (CDT)

TRISH REPLY:TOstryzniuk 10:20, 23 December 2008 (CST) **if this is the working DX that the physician is treating then this is what the collector must code as the DX.

note

• • If a patient doesn't meet the criteria for shock or severe sepsis to a tee then what would the DX be then? I don't expect 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.
  • FYI: We have a similar problem with the DX of ARF, CRF and ARI in that there is no consistent definition that physicians follow when documenting this DX in the charts. For renal failure DX, the collectors are asked to follow the collection guide regardless of what physician is charting. The collection guide criteria for the renal failure DX is simple, unlike the septic shock criteria.TOstryzniuk 10:20, 23 December 2008 (CST)

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

• • reminder that Dr. Kumar has not yet responded to this question, and eagerly awaiting resolution.--JHutton 10:02, 29 October 2008 (CDT)
    • follow up sendTOstryzniuk 20:04, 22 December 2008 (CST)
      • DONETOstryzniuk 10:20, 23 December 2008 (CST)