Template:ICD10 Guideline Sepsis

This template info about coding sepsis to keep it consistent across pages.

To use:

{{ICD10 Guideline Sepsis}}

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• 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
  • 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 (i.e. shock, hypoperfusion)
• Although a person can evolve over time from one to a more advanced subtype, at any one time you should only code ONE of these 3 entities
• REGARDING IDENTIFYING THE ORGANISM RESPONSIBLE:
  • Until 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
  • e.g. Patient has severe sepsis with the acute organ failure being acute renal failure due to ATN --- and it's felt to be due to a pseudomonas pneumonia. So in this case the pseudomonas is the bug that should be combined with the pneumonia AND also with the severe sepsis.

e.g. Patient with septic shock has an E.coli UTI and a pseudomonas pneumonia. The team is not certain which of those two bacteria is causing the septic shock, but of course is treating them both. In this cas the bug is known to be a bacterium, but not clear which, so the bug to combine with the Septic shock is Bacteria, NOS

Collection criteria:

• acute failure of one of more organs in the setting of infection, and presumably due to the infection. The official definition of this per the SEPSIS-3 guidelines is an acute increase in the SOFA score by 2 or more.

We had decided to shelve the discussion about using the SOFA score until after ICD10 (see SOFA scoring. So how will we collect this until then?

• SMW

• Cargo

• Categories

• The 2016 consensus group defined the ORGAN DYSFUNCTION as an acute CHANGE from patient's baseline total SOFA score by 2 or more points -- where the baseline SOFA score can be assumed to be 0 in patients not known to have preexisting organ dysfunction.

background about 2016 sepsis consensus

Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016). These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS).