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|Pre-ICD10 counterpart:||Septic Shock|
|APACHE Como Component:||none|
|APACHE Acute Component:||Sepsis|
|External ICD10 Documentation|
- 1 Additional Info
- 2 Alternate ICD10s to consider coding instead or in addition
- 3 Candidate Combined ICD10 codes
- 4 Related CCI Codes
- 5 Data Integrity Checks (SMW)
- 6 Related Articles
- As of January 2019, we are still using the SEPSIS-2 approach to diagnosis. Sometime in 2019 we expect to switch over to the SEPSIS-3 definition. SEPSIS-2 delineates 3 subtypes of sepsis:
- Sepsis (SIRS due to infection, without acute organ failure) -- defined as SIRS due to a known or presumed infection but NOT satisfying criteria for severe sepsis or septic shock (see SIRS critera, below)
- Severe sepsis -- defined as sepsis PLUS one or more acute organ failures
- Shock, septic -- defined as severe sepsis where an acute organ failure is the cardiovascular system (see criteria below)
- Note that an individual during a single episode of illness can evolve over time from a less advanced to a more advanced subtype of sepsis --- and as this occurs, make sure to code the more advanced subtypes as they occur
Identifying the organism responsible
- Until Jan 2019, the rule was that you only identify the responsible organism if it was present in blood culture. THIS RULE HAS CHANGED AS OF 1/1/2019 -- because in fact the majority of even septic shock cases never grow anything from the blood and most derive from localized infections (pneumonia, UTI, etc)
- The rule now is that you make all efforts to identify the specific organism, even if the blood cultures never grow anything
- At the same time, however, if the person IS bacteremic, then you must ALSO code the Bacteremia -- see that article for information on whether or not to link the bacteremia code to others.
Coding of the sepsis diagnoses
- Usually we say that related diagnoses should be combined with the same priority.
- But for a technical reason having to do with how we combine diagnoses, this is NOT the case for the 3 sepsis diagnoses
- DO combine it with the bug, and if the bug is resistant with the bug resistance code
- But do NOT combine it with the infection thought to be the cause of the sepsis --- e.g. if it's believed that the pneumonia is the cause of the sepsis, code them both but do NOT combine them
Criteria for SIRS
- SIRS is defined as 2 or more of the following things:
- Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
- Heart rate of more than 90 beats per minute
- Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
- Abnormal white blood cell count (>12,000/µL or <4,000/µL or >10% immature [band] forms)
Criteria for the SHOCK in Septic Shock
- Persisting hypotension requiring vasopressors to maintain MAP>65mmHg AND serum lactate>2 mmol/L -- both despite adequate volume resuscitation.
- The CAUSE is proven infection OR presumed infection -- thus positive cultures are not required.
if someone has another obvious cause of shock (e.g. massive hemorrhage) and also has infection, that does not mean it is combined hemorrhagic and septic shock. Basically, septic shock should not be called if there is another obvious cause for shock.
- Also recognize that not all vasodilatory (aka distributive) shock is due to infection. When it is due to infection then use THIS code, when it's not due to infection, then use one of the other appropriate codes, such as: Anaphylactic reaction (anaphylaxis), or Shock, NOS
|background about 2016 sepsis consensus|
Alternate ICD10s to consider coding instead or in addition
- Anaphylactic reaction (anaphylaxis) -- includes anaphylactic shock
- Bacteremia AND Fungemia, NOS -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).
Candidate Combined ICD10 codes
- Also code the causative infection.
Related CCI Codes
Data Integrity Checks (SMW)
|Check Inf Pathogens must have Infection requiring pathogen or Potential Infection||CCMDB.mdb||implemented|
|Query s tmp QASeptic tmp no dx||CCMDB.mdb||implemented|
|Query s tmp QASeptic Dx no tmp ICD10||CCMDB.mdb||implemented|
|Check Inf Infection requiring pathogen must have pathogen combined code||CCMDB.mdb||implemented|