Septicemia/Bacteremia/Fungemia

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) - subcode (64) - negative blood culture
  • septicemia (46) - subcode (68) - Unknown pathogen, if you are not clear which bug is causing the infection.

Also see: Septic Shock or Severe Sepsis

• 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)

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

• 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).

• • 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 ReplyTOstryzniuk 10:20, 23 December 2008 (CST).

• • • 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

• • 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)

• • • septicemia (46) – subcode (65) –negative culture (if blood culture was sent & no bugs ID’d).
    • OR
    • septicemia (46) – subcode (92) –no culture sent (if no blood culture was sent).

• 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).
  • TRISH REPLY:TOstryzniuk10:20, 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 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.
• 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)
  • So the criteria for coding septic shock and septicemia has changed and we do not have to follow the criteria in the code book? If sepsis is the is doctors working diagnosis than code that regardless of our former criteria? If this is a change in the way we are data collecting should we make sure everyone knows in a email? I would hate information this important being missed!GHall 14:18, 7 January 2009 (CST)
    • OK I have talked to Tina and she feels email is not a good method of communicating the changes to coding. She encourages people to click on the "diff" to identify changes. She has shown me how to do this and it does look like a good way to find out what has really changed.GHall 14:36, 7 January 2009 (CST)