Severe Sepsis and Sepsis codes –Gram Positives Vs Gram Negatives:
Severe Sepsis, sepsis and SIRS have a great coding rules .You would have to go to the guidelines to do it correctly. Depending upon the sepsis or severe sepsis was present at the time of admission or not, documented , document unclear and so on criteria are there and for sequencing them which is to be Primary /secondary and so on. Well you would have to assign the systemic infection code 995.91 0r 995.92 according to sepsis or severe sepsis.
A code should also be asigned for any localized infection,if present
As per the coding of your both organisms you would have to . The enterococcus usually a commansal of GIT and as 'opportunistic Pathogen', it can be a cause for local infection . Septicemia due to enterococcus is very rare than the streptococcus, which is a most prevalent and commonest gram positive organism to cause Severe Sepsis and Septicemia. It is most likely the enterococcal infection is selfevolved from the patient / hospital nosocommial in origin and most likely a local infection
So you would have to assign three codes depending upon your doctors document.
Q.2) The gram positive organisms are those which stain methylene blue in Grams stain technique in the smear. To mention some of them- Streptococcus, staphylococcus, enterococcus, Pneumococcus, bacillus, Cornebacterium diphtheroids, Listeria moncytogenes, and some of the anerobes like Clostridium group, actinobacteria, Nocardia etc
The gram Positive Septicemia is rarer than the Gram Negative ones and the complications like Septic shock and DIVC like severe complications are common with gram negatives. But the gram positive Methicillin Resistant Staph aureus MRSA,is notorious for the infection ,and producing sever sepsis and septicemia.
I hope my note is useful to some extent.
