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.
How to code viral sepsis has been a topic of discussion on AHIMA’s Engage Coding, Classification and Reimbursement community, and has be the subject of several inquiries to AHIMA’s Code-CheckTM coding question service.
The viral sepsis coding confusion may come into play when you look up Viral Sepsis in the Alphabetic Index. Under the main term Sepsis, there is not a subterm of Viral. If you look up Virus, viral, you are directed to see also condition.
My recommendation for this is if the cause of the sepsis is suspected to be a virus then through the index we search sepsis. Under Sepsis there is an indented term of specified organism A41.89 which is “Other Sepsis” in the tabular.
Sepsis (generalized)(unspecified organism)A41.9
Specified organism NEC A41.89
Then, since it is documented as a viral cause in the index under virus, as cause of disease classified elsewhere assigns B97.89. The description for B97.89 is Other viral agents as the cause of diseases classified elsewhere.
Virus, viral – see also condition
as cause of disease classified elsewhere B97.89
The note in the tabular under Bacterial and viral infectious agents (B95-B97) states, “These categories are provided for use as supplementary or additional codes to identify the infectious agents in diseases classified elsewhere.”
Also, based on coding guidelines, it states to indicate the infection if a second code is needed. It is our interpretation that this makes the coding more complete.
ICD-10-CM Guideline I.C.1.b.
b. Infectious agents as the cause of diseases classified to other chapters
Certain infections are classified in chapters other than Chapter 1 and no organism is identified as part of the infection code. In these instances, it is necessary to use an additional code from Chapter 1 to identify the organism. A code from category B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified to other chapters, B96, Other bacterial agents as the cause of diseases classified to other chapters, or B97, Viral agents as the cause of diseases classified to other chapters, is to be used as an additional code to identify the organism. An instructional note will be found at the infection code advising that an additional organism code is required.
As of press time, the most current Coding Clinic, from the third quarter of 2016, recommends the assignment of A41.89 and B97.89 for viral sepsis.
The American Hospital Association Central Office also received many questions related to viral sepsis coding issues. They dedicated several pages specifically to sepsis coding issues in this issue of Coding Clinic. Some of the questions addressed in the issue included:
How would viral sepsis be coded in ICD-10-CM? The type of viral infection is unspecified. In ICD-9-CM, “Viral” was a subterm under septicemia, but it is not present as a subterm under sepsis in ICD-10- CM. By selecting “sepsis with specified organism NEC” code A41.89 is referenced. However, in ICD-10-CM, categories A30-A49 encompass “other bacterial diseases.” Would it be appropriate to assign a bacterial code for a viral condition?
How would a diagnosis of “sepsis secondary to viral syndrome” be coded? The viral syndrome, in this case, is not further specified.
What codes should be assigned for a final diagnosis of viral sepsis secondary to acute rhinovirus bronchitis? The sepsis was present on admission.
What are the correct ICD-10 CM codes for a provider’s diagnostic statement of “viral sepsis due to acute viral bronchitis due to influenza A?” The sepsis was present on admission.
When you do run into challenging cases, there are many helpful resources available to assist in answering tough coding questions. To receive official ICD-10-CM and ICD-10-PCS coding advice, you can send questions to the American Hospital Association’s Coding Clinic. AHIMA’s Engage communities are a great place to ask coding advice from other coding professionals that may have encountered similar situations, and AHIMA’s Code-Check™ service (http://www.ahima.org/topics/codecheck) provides expert coding advice as well.