Bacteremia

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	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

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!
• Bacteremia is a lab finding, not a disease. If the patient has a known infection AND/OR Severe sepsis OR Shock, septic you MUST code those. This follows our general rule, code symptoms, signs and diagnostic abnormalities when the underlying cause is unknown. If that cause is known, then of course you must code the cause, and coding the abnormal finding is optional.

So we treat the bacteremia dx essentially as a type of Category:Testing? Should it go into that category, then? It would be the only thing in both infection and testing. Should Colonized with organism (not infected) be treated the same, then, ie added to testing, with whatever templates apply? AG REPLY -- it is in the larger category of findings/symptoms/signs, rather being an actual disease. It could go in the testing category I guess. Colonized is not the same -- though testing is required, it's a diagnosis that requires interpretation/judgement to decide that the bugs are colonizers and not an actual infection.

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I just realized that this would mean that symptom and test codes in our ICD10 data will be spotty. Currently we have Template:ICD10 Guideline Symptoms not needed when cause known to give this instruction for signs and symptoms, and that template is not included in Category:Testing dxs. Should we be consistent about this? Ttenbergen 10:15, 2018 September 21 (CDT)

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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

• 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 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)

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

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