Bacteremia: Difference between revisions

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*[[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!]]
*[[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
*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. Klebsiella pneumonia with to Klebsiella bacteremia), but if it’s not completely clear that they’re related, code the bacteremia seperately as “free standing”. {{DA | what do you mean by free-standing? Do you mean not to use [[Combined ICD10 codes]]? Bacteremia is in [[:Category:Infection requiring pathogen]], so it has to be coded with a pathogen. Do you mean it should be coded with [[Infectious organism, unknown]] or similar? Ttenbergen 13:36, 2019 February 1 (CST); Just to clarify:  when a patient has septic shock and we put in the pathogen from a positive blood culture, do we also have to code bacteremia? OR is this code only for positive blood cultures where the source is not known?--[[User:LKolesar|LKolesar]] 14:20, 2019 February 12 (CST)}}
**Furthermore, at the discretion of the data collector, they can be coded as [[Combined ICD10 codes]] with another presumed infection (e.g. Klebsiella pneumonia with to Klebsiella bacteremia), but if it’s not completely clear that they’re related, code the bacteremia seperately as “free standing”.  
***If you include any of the sepsis codes AND you have bacteremia, then it's a clinical decision of whether or not to link those two codes.
 
{{DA |  
* what do you mean by free-standing? Do you mean not to use [[Combined ICD10 codes]]? Bacteremia is in [[:Category:Infection requiring pathogen]], so it has to be coded with a pathogen. Do you mean it should be coded with [[Infectious organism, unknown]] or similar? Ttenbergen 13:36, 2019 February 1 (CST); }}
 
{{DA |
*Just to clarify:  when a patient has septic shock and we put in the pathogen from a positive blood culture, do we also have to code bacteremia? OR is this code only for positive blood cultures where the source is not known?--[[User:LKolesar|LKolesar]] 14:20, 2019 February 12 (CST)}}
***If you include any of the sepsis codes AND you have bacteremia, then it's a clinical decision of whether or not to link those two codes. }}


=== Bacteremia is '''not''' a blind replacement for old septicemia dx! ===
=== Bacteremia is '''not''' a blind replacement for old septicemia dx! ===

Revision as of 18:25, 2019 February 13

ICD10 Diagnosis
Dx: Bacteremia
ICD10 code: A49.9
Pre-ICD10 counterpart: Septicemia
Charlson/ALERT Scale: none
APACHE Como Component: none
APACHE Acute Component: 2019-0: Neuro NOS
Start Date:
Stop Date:
External ICD10 Documentation

This diagnosis is a part of ICD10 collection.

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    • 2019-01-01
    • 2999-12-31
    • A49.9
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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. Klebsiella pneumonia with to Klebsiella bacteremia), but if it’s not completely clear that they’re related, code the bacteremia seperately as “free standing”.


  • SMW


  • Cargo


  • Categories


  • Just to clarify: when a patient has septic shock and we put in the pathogen from a positive blood culture, do we also have to code bacteremia? OR is this code only for positive blood cultures where the source is not known?--LKolesar 14:20, 2019 February 12 (CST)
  • SMW


  • Cargo


  • Categories
      • If you include any of the sepsis codes AND you have bacteremia, then it's a clinical decision of whether or not to link those two codes. }}

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".

Alternate ICD10s to consider coding instead or in addition

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 Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.

Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site

  • This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
    • The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
  • As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
  • And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.

Attribution of infections

See Attribution of infections

  • Code the organism
  • Others, as mentioned above.

Related CCI Codes

Data Integrity Checks (automatic list)

 AppStatus
Query check ICD10 Inf Infection req Pathogen must have oneCCMDB.accdbimplemented
Query Check Inf Pathogens must have Infection requiring pathogen or Potential InfectionCCMDB.accdbimplemented

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