EmailACS 0110 Septicaemia
Publication Date: December 2005
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 2182
A one month old male patient presents with fever (38.9) and irritability (HR 120bpm). The patient was admitted with initial notes indicating a 'probable UTI'. A full septic work up was completed. Results from this indicated a UTI which grew enterobacter and klebsiella species (sensitive to Gentamicin) CSF culture was negative. The patient was treated with antibiotics and discharged 4 days later.
According to the information provided in the medical record, we would've coded the case as:
N39.0 Urinary tract infection, site not specified
B96.1 Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified to other chapters
B96.88 Other and unspecified bacterial agents as the cause of diseases classified to other chapters
However on reading ACS 0110 Septicaemia we are slightly confused.
According to the standard the definition of SIRS is manfiested by two or more of the following:
Temperature >38 C or <36 C
Respiratory rate >20 breaths/min or PaCO2 of <32 torr
Heart rate >90 beats/min
Leukocyte count >12,000/L or <4,000/L or >10% immune (band forms)
This patient has both a high temperature and a high heart rate (per min). Does this mean this patient meets the defintion of SIRS and we can code it to Sepsis? We are having trouble interpreting this standard as many of our patients presenting with fever have a septic workup, however final diagnosis is often UTI. Most have a high temperature and are treated with IV antibiotics. How does ACS 0108 Sepsis secondary to UTI/Urosepsis also come into play here?
Search Details:
Septic work ups are often completed on our patients and prophylactic antibiotics commenced to cover the risk of sepsis.
According to the information provided in the medical record, we would've coded the case as:
N39.0 Urinary tract infection, site not specified
B96.1 Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified to other chapters
B96.88 Other and unspecified bacterial agents as the cause of diseases classified to other chapters
However on reading ACS 0110 Septicaemia we are slightly confused.
According to the standard the definition of SIRS is manfiested by two or more of the following:
Temperature >38 C or <36 C
Respiratory rate >20 breaths/min or PaCO2 of <32 torr
Heart rate >90 beats/min
Leukocyte count >12,000/L or <4,000/L or >10% immune (band forms)
This patient has both a high temperature and a high heart rate (per min). Does this mean this patient meets the defintion of SIRS and we can code it to Sepsis? We are having trouble interpreting this standard as many of our patients presenting with fever have a septic workup, however final diagnosis is often UTI. Most have a high temperature and are treated with IV antibiotics. How does ACS 0108 Sepsis secondary to UTI/Urosepsis also come into play here?
Search Details:
Septic work ups are often completed on our patients and prophylactic antibiotics commenced to cover the risk of sepsis.
Response
A patient must have documentation of SIRS or sepsis for this to be coded. Definition information in the ACS is provided for information only, and not for diagnostic purposes. Coders should follow the information in the 'Classification' section of the ACS.
