Inpatient Facility Coding & Compliance Alert

Question: I have trouble distinguishing between sepsis, septicemia, and similar conditions. Could you explain what septic shock is?
Answer: The term "septic shock" generally refers to circulatory failure associated with severe sepsis, so it represents a type of acute organ dysfunction. When you code cases of septic shock, follow the guidelines for severe sepsis. You'll need to report four diagnosis codes, in this order:

1. The diagnosis representing the initiating system infection or trauma, such as acute pancreatitis (577.0)
2. Either 995.92 (Severe sepsis) or 995.94 (Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction)
3. The diagnosis to identify the organ failure, such as acute kidney failure (584.5-584.9)
4. 785.52 (Septic shock).

Because septic shock indicates the presence of severe sepsis, the physician isn't required to document both severe sepsis and septic shock. However, stress to your physicians that the more they document, the more accurate your coding choices – and the bottom line reimbursement – will be.
Looking ahead: When ICD-10 goes into effect, you'll have a consolidated code to report instead of both 995.92/995.94 with 785.42. The new option will be R65.21 (Severe sepsis with shock).

More info: For more on coding sepsis cases, see Decipher the Differences Between Urosepsis, Septicemia, and More.