Bacteremia

ICD10 Diagnosis
Dx:	Bacteremia
ICD10 code:	A49.9
Pre-ICD10 counterpart:	Septicemia
Charlson/ALERT Scale:	none
APACHE Como Component:	none
APACHE Acute Component:	Neuro NOS
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

This lists as Apache Neuro and is in APACHE Acute Dxs in ICD10 codes because it is in the following range: Nonop - Large categories - Neuro NOS - A17. - A69.22 When we touched on this at an Allan's list meeting you agreed that probably wasn't right. Emailed Allan. Ttenbergen 15:42, 2019 June 25 (CDT)

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Additional Info

• Bacteremia is a clearcut entity, which means bacteria circulating in the blood, and not due to contaminated blood culture. #Bacteremia is not a blind replacement for septicemia!
• NOTE: Bacteremia is a finding, not a specific disease. And even though the general rule is that coding findings/signs/symptoms is optional when the underlying cause is known, you should ALWAYS specifically code bactermia when present
  • Furthermore, at the discretion of the data collector, they can be coded as Combined ICD10 codes with another presumed infection (e.g. 1.Pneumonia with Klebsiella as the bug + 2.Bacteremia with Klebsiella as the bug), but if it’s not completely clear that those two infections are related to each other, then still code them both of course, but don't 1 and 2 together.
  • When a patient has septic shock with bactermia you should code both -- and link them together if the same bug is responsible for both.

Bacteremia is not a blind replacement for old septicemia dx!

The word "septicemia" is and always has been confusing, if not completely meaningless. It has been used both to mean pathogens in the blood (which is bacteremia or Fungemia, NOS), to mean toxic products of bugs in the blood (such as LPS or endotoxin which cause some of the clinical manifestations of Severe sepsis/Shock, septic), and to mean sepsis or Shock, septic. So going forward we don't need or want a replacement for that vague entity "septicemia".

Repeated events

If this happens repeatedly during the same ward or unit stay, only code it the first time it happens, rather than each time it happens. See ICD10 codes only coded the first time for other diagnoses coded this way.

Example:

A person has a self-limited episode of A-fib. It goes away and then recurs. Only code the first one. A person has a self-limited episode of A-fib. It goes away but then he has an episode of V-tach. As this is a different diagnosis, both of these should be listed, but only code once each. Patient comes in with hypokalemia. It’s treated and remits, but the next day it recurs. Only code the first time.

1 Acquired Diagnosis / Complication says this is true for all acquireds, so why would we need that instruction? Ttenbergen 13:12, 2019 August 1 (CDT)

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Repeated events

If this happens repeatedly during the same ward or unit stay, only code it the first time it happens, rather than each time it happens. See ICD10 codes only coded the first time for other diagnoses coded this way.

Example:

A person has a self-limited episode of A-fib. It goes away and then recurs. Only code the first one. A person has a self-limited episode of A-fib. It goes away but then he has an episode of V-tach. As this is a different diagnosis, both of these should be listed, but only code once each. Patient comes in with hypokalemia. It’s treated and remits, but the next day it recurs. Only code the first time.

1 Acquired Diagnosis / Complication says this is true for all acquireds, so why would we need that instruction? Ttenbergen 13:12, 2019 August 1 (CDT)

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Alternate ICD10s to consider coding instead or in addition

• Shock, septic
• Severe sepsis
• Sepsis (SIRS due to infection, without acute organ failure)
• Any infection that is the source of this bacteremia.
• Fungemia, NOS
• Bacterial infection, NOS
• Fever or fever of unknown origin (FUO)

Candidate Combined ICD10 codes

Infections

Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Infections in ICD10 for more info.

Infection requiring pathogen

This diagnosis is an infection that requires a pathogen to be coded.

• Code the organism
• Others, as mentioned above.

Related CCI Codes

Data Integrity Checks (SMW)

	App	Status
Check Inf Pathogens must have Infection requiring pathogen or Potential Infection	CCMDB.mdb	implemented
Query check ICD10 Inf Infection req Pathogen must have one	CCMDB.mdb	implemented

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