ED Coding and Reimbursement Alert

Diagnosis coding success eliminates mistakes

If you're mixed up about which codes to report for sepsis and SIRS, you're not alone. And if you're unfamiliar with its exact pathology, you can easily misinterpret documentation -- which doesn't help your confusion. Follow these expert hints to spot giveaway terms and symptoms.
 
Coders often mistake a diagnosis of "sepsis" and "SIRS" (systemic inflammatory response syndrome) with infection, when the former conditions are actually responses to infection, says James Kennedy, MD, CCS, vice president of MA Health Solutions Inc. in Nashville, Tenn. A patient cannot develop sepsis without first having SIRS -- and SIRS may or may not result from infection. Determine Severity for Correct SIRS Code Depending on the intensity of the patient's SIRS, the presence or absence of organ failure, and whether the inflammatory response is due to infection, you will choose one of the following codes:

995.90 -- SIRS, unspecified
995.91 -- SIRS due to infectious process without organ dysfunction
995.92 -- ... with organ dysfunction
995.93 -- SIRS due to noninfectious process without organ dysfunction
995.94 -- ... with organ dysfunction. You should note that code 995.91 is the same as sepsis, Kennedy says. For 995.92, however, you must see the phrase "severe sepsis" (which is generally defined as requiring organ system failure) to report it -- even if you know the patient's condition by looking at the chart -- so make sure your physicians know they need to write those specific words.

"You need the symptoms of SIRS to use the 995 code, and sepsis should only be used if it's specifically stated as sepsis," says Kimberly Engel, coder at Infinity Healthcare SC in Mequon, Wis. When reporting codes that describe SIRS with organ failure (995.92 and 995.94), be sure to report the code for the dysfunction and underlying condition in addition to the SIRS code.

For example, suppose the documentation states that the patient has sepsis from a viral infection and has organ failure because of it. In this case, you would first report the underlying condition, the infection itself, with 079.99 (Unspecified viral infection). Then you would report the sepsis with 995.92, as long as the doctor has stated "severe sepsis."

Finally, you would code for the symptoms of the organ dysfunction. For instance, if the patient had respiratory failure and renal failure, you may report 518.81 (Acute respiratory failure), and 584.9 (Acute renal failure, unspecified), depending on the nature of the dysfunction. Understand SIRS to Understand Sepsis Sepsis, by definition, is the systemic inflammatory response to infection manifested by certain SIRS conditions. Essentially, if the patient has an infection and develops SIRS, the intersection of these conditions is sepsis.

SIRS may result from a number of conditions, including [...]