Septicemia/Bacteremia/Fungemia

Definition

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:

Also see: Septic Shock or Severe Sepsis

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)

• 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.

Discussion

• 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.
  • 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)
    • Coding here has not changed from what is in the code book.TOstryzniuk 16:33, 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).
        • That is great. New tool. Takes time for everyone to learn how to use it.TOstryzniuk 16:33, 7 January 2009 (CST)
    • I have never seen a doctor call something septicemia when blood cultures are negative. They however do occasionally call a patient septic or having sepsis which only means that the pt is presenting with symptoms of infection but may or may not have positive cultures. I don't think our criteria has changed at all and I think we have to be very careful not to call things septic shock or septicemia without specific criteria. I diagree with the changes being made. --LKolesar 15:33, 7 January 2009 (CST)
      • There are no changes being made. Physicians do document this DX without positive blood cultures. When Dr. Kumar reviews the data, he has the option to pull charts and look at those profiles that had the DX of septicemia but no blood culture was sent to confirm this DX.TOstryzniuk 17:21, 7 January 2009 (CST)
        • Although a patient may show clinical evidence of septicemia, the blood culture may be negative due to difficulty in culturing fastidious organisms from blood, growth inhibitory factors in the blood, or initiation of specific antibiotic therapy before laboratory test samples are taken. 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)

• 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)
• Shirley Kiesman's question, is in regards to urosepsis. This

thread should stay in the septicemia content until clarified.WGobert 10:13, 8 January 2009 (CST)

• • Historically at the Vic, when a Dr. had a working DX of urosepsis, unless there was a positive blood culture, we have coded this only

as code 51 cystitis. On page 10 of the code book, septicemia is defined as positive blood cultures. So if code 51 is to include urosepsis, do we now code the 51 cystitis plus 46 septicemia, subcode 92 no culture sent? This changes the way we will collect urosepsis here at the vic.WGobert 10:17, 8 January 2009 (CST)