Coding Sepsis vs. Septic Shock

Overseen by AHIMA’s coding experts for the Journal of AHIMA website, the Code Cracker blog takes a look at challenging areas and documentation opportunities for coding and reimbursement. Check in each month for a new discussion.


 

The definitions and clinical criteria of sepsis and septic shock have been revised, per an article published February 23, 2016 in the Journal of the American Medical Association (JAMA). The recommendations from the 19 physician members of the task force that wrote the new definitions were:

  • “Sepsis should be defined as a life-threatening organ dysfunction caused by dysregulated host response to infection.”
  • “Septic shock should be defined as a subset of sepsis in which particularly proud circulator, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.”

The below table shows the new clinical criteria:

Sepsis vs. Shock Table

What does this change mean for the coding professional? Coders still need to be assigning codes based on physician documentation. What might change is the clinical validation portion of sepsis and septic shock by both CDI and coding professionals. Facilities may need to adopt (or revise existing) internal policies on how to consistently and compliantly code sepsis and septic shock based on these new definitions.

How is your facility dealing with this definition and clinical criteria change? Has this impacted your coding or CDI staff at all?

Read the article “The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)” published in JAMA here.

Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, is senior director of HIM practice excellence, coding and CDI products development at AHIMA. She has over 15 years experience in HIM and coding, with her most recent focus being in ICD-10-CM/PCS, and has presented numerous times at the regional, state, and national levels on HIM and coding topics. She was previously a director of HIM practice excellence, focusing on coding products, resources, and education, at AHIMA. Melanie is an AHIMA-approved ICD-10-CM/PCS trainer and an ICD-10 Ambassador.

4 Comments

  1. Hi Melanie, surely you are the inspiring ambassador in AHIMA world for students like me and professionals in this field. I am just beginning my journey into HIM courses yet your profile already sailing me to deeper ocean full of treasure.

    thanks

    Salim

    College of the Mainland, Texas

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  2. With the new definitions, when would codes in the A4X.XX be used?

    My understanding is the term septicemia is the same as sepsis. If sepsis is specific to organ dysfunction, when would it be appropriate to code septicemia from the Chapter 1?

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    • Hi Claudia!

      When you look up Septicemia in the Index of ICD-10-CM, it leads you to the default code of A41.9. It also has a subterm that says “meaning sepsis – see Sepsis.”

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  3. Melanie – thanks for the response. To expand on that, with the change to the clinical criteria which states sepsis is specific to organ dysfunction and that severe sepsis is redundant, would codes in Chapter 1 be coded to identify sepsis in addition to the code for the specific organ dysfunction, without coding R65.20?

    Thanks.

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