# Urosepsis vs UTI



## heatherwinters

I am very confused.  The clinician documented the patient has "mild urosepsis with gram-negative rods, ID and sensitivities pending".  The urine culture was greater than 100,000 gram negative rods.  On his billing sheet, he wants to bill Sepsis for the hospital encounter.   Do I use 599.0 or 995.91.  On the subsequent hospital day, the documentation indicates Mild sepsis due to ecoli from urinary source-pyelonephritis.  
Question: How would I code the first day
How would I code the second day

I am very confused about whether to code as 599.0 with 041.4 or if I use 995.91 and 041.4.


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## Rani

Heather--

At the meeting I went to awhile ago just for this issue, we were told that to code the sepsis, there has to be certain criteria met--there have to be co-conditions due to the sepsis such as, fever, funky blood work results etc.  Otherwise, you have to code down to the 599.0-UTI.
I don't have my "cheat sheet" in this office today otherwise I could give you better specifics--but hope I helped some.


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## mitchellde

Go to the guidelines for ICD-9 the subject of sepsis is well covered.  You must code an organism first listed so the ecoli, then the 995.9x secondary


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## heatherwinters

*Sepsis*

Icd-9 states you cannot code sepsis unless two or more of the following symptoms are documented: fever, tachycardia, tachypenia, leukocytosis aor leukopenia.  If the doctor writes Sepsis, however, there is no documentation in the note of two of these, then you cannot use a 995.9 code, correct?


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## mitchellde

You can code sepsis if the physician documents sepsis.  The physician is allowed to state any infection diagnosis based on the clinical presentation of the patient.  Where are you reading the part about needing the presence of two or more symptoms?


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## heatherwinters

*Sepsis*

Icd-9-cm 995.9 DEF in the 2010 expert book.
DEF: CLINICAL RESPONSE TO INFECTION OR TRAUMA THAT CAN TRIGGER ACUTE INFLAMMATORY REACTION AND PROGRESSES TO COAGULATION, IMPARIED FIBROINOLYSIS, AND ORGAN FAILURE; MAINFESTED BY TWO OR MORE OF THE FOLLOWING SYMPTOMS: FEVER, TACHYCARDIA, TACHYPNEA, LEUKOCYTOSIS OR LEUKOPENIA

See also
http://www.hcpro.com/content/202827.pdf


> Sepsis, code 995.91: is synonymous with SIRS due to infection without organ dysfunction. This is an infection-induced syndrome defined by the presence of two or more of the following features of systemic inflammation:
> – Fever (oral temperature > 38°C or 100.4°F) or hypothermia (oral temperature < 36°C or 96.8°F)
> – Leukocytosis (white count > 12,000) or leukopenia (white count < 4,000 or > 10% bands)
> – Tachycardia (> 90 beats per minute)
> – Tachypnea (respiratory rate > 20 breaths per minute or
> a pCO2 of < 32 mmHg)


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## mitchellde

Ok that is a clinical description of sepsis, however the physician does not have to list these symptoms nor do we have to look for them in the documentation, If the physician documents the condition as sepsis then we code it.  Also if we only see the clinical indications of sepsis listed by the physician we as the coder do not assign a dx of sepsis.


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## coder17

So if you have listed urosepsis due to streptococcus then an addendum to the record states sepsis with streptococcus septicemia and uti due to streptococcus B, you would code the it as sepsis not urosepsis correct?


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## mitchellde

There is no code for urosepsis so you would code the infection, the sepsis, and the local infection which all adds up to the condition of urosepsis.   
FYI - ICD -10 CM if the provider documents urosepsis, we cannot code it we must query for a better diagnosis, we are not allowed to default to the UTI unspecified code.  Per the guidelines.


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## tmlbwells

I was taught that a lot of doctors use urosepsis interchangeably with UTI, so I've coded it as 599.0 is there isn't any other documentation.


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## mitchellde

It is not interchangeable with UTI.  That is the problem, it needs to be clarified in the documentation so that it can be coded correctly.


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