ED Coding and Reimbursement Alert

Sepsis-related terms making your head spin? Refer to this list when you need a little extra guidance.
 
Infection -- In a sterile area of the body, this indicates the presence of micro-organisms. In a nonsterile area, it indicates either unusual micro-organisms or an unusual number of normal micro-organisms. Infections can be "specified," such as 079.2 (Coxsackie virus), or "unspecified," such as 079.99 (Unspecified viral infection).

SIRS -- The acronym for "systemic inflammatory response syndrome," SIRS may occur in response to multiple causes, only one of which is infection. When SIRS is due to infection, we call it sepsis. Symptoms include increased or decreased body temperature, rapid heartbeat, high or low white blood count, and increased respiration. You can describe SIRS with the 995.90-995.94 series.

Multiorgan dysfunction (or failure) syndrome -- This condition may result from SIRS, and it accompanies severe sepsis involving the failure of one or more organ systems.

Sepsis -- SIRS resulting from infection. You'll report 995.91 (Systemic inflammatory response syndrome due to infectious process without organ dysfunction) or 995.92 (... with organ dysfunction). According to Coding Clinic for fourth quarter 2003, SIRS "implies that a localized infection has advanced to the point of a systemic infection (septicemia)."

Bacteremia -- Presence of bacteria in the blood, as confirmed by a positive blood culture. The condition may occur after a surgical procedure, labor, or teeth cleaning, and according to Coding Clinic 2000, "progresses to septicemia only when there is a more severe infectious process or an impaired immune system." Make sure you code it as a lab finding only (790.7, Bacteremia), because you need more information from the physician to determine its clinical significance. Of note, this type of specific information is rarely available in the ED when the patient first presents.

Keep in mind, says Coding Clinic for fourth quarter 2003, that bacteremia is not just defined by the presence of bacteria in the blood, but by "bacteria in the blood without an associated inflammatory response."

Septicemia -- Similar to bacteremia, but the term "septicemia" implies greater severity. This definition can be confusing because it technically has the same description as bacteremia, but it doesn't require a positive blood culture. Coding Clinic 2000 does offer a little help, though: "It appears that by definition a patient cannot have septicemia unless he has SIRS." But don't confuse the term with "sepsis," warns the findings of the ICD-9-CM Committee Meeting of 2002.

"Most physicians don't use this term much," says James Kennedy, MD, CCS, vice president of VP-MA Health Solutions Inc. in Nashville, Tenn. "They use 'sepsis' or 'severe sepsis.' "

Coding Clinic for fourth quarter 2003 defines septicemia as "pathological organisms (viruses, bacteria, fungus, or other organisms) OR their toxins in the blood."

Sepsis syndrome -- While physicians may describe a condition using this term, it's not listed in the Index to Diseases. The physician may mean "septicemia" or "severe sepsis," but you'll have to query her if you're to code either one.