Coding, Classification & Reimbursement

1.  Sepsis due to (in) pyelonephritis

Posted 10-07-2017 12:16
Hi guys, How do yall code sepsis due to (in) pyelonephritis? I assigned codes A41.9 and N16 per the index. I was asked by CDI to change the N16 to N12 since it's a CC. In my opinion, per the index, only the diagnosis pyelonephritis, NOS, would be coded N12. I sent a question to Coding Clinic in August, but have yet to receive an answer. Thoughts? thanks

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Dianna Bethany
RHIT, CCS, CDIP, ICD-10 Trainer
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2.  RE: Sepsis due to (in) pyelonephritis

Posted 10-07-2017 15:03

Hi,

 

Yes I would use N16 also as the index states pyelonephritis in (due to) sepsis is N16 and this is a manifestation code.  So probably excludes as a cc with sepsis pdx.  N 12 is probably for pyelonephritis without systemic sepsis..and with other pdx will be cc..

 

 

Sharon Hekimian, RHIT CCS                                                                

HIM Coder

PH #  781-453-5215

HOME OFFICE  # 617-312-9205

FAX # 781-453-5783 ATTN: SHARON

 






3.  RE: Sepsis due to (in) pyelonephritis

Posted 10-08-2017 15:20
Dear Dianna,

As a core coding rule you would NEVER EVER code directly from the index. You ALWAYS go to the Tabular List. If you would have done so in this case you would have clearly seen that N16 is the code for Pyelonephritis.

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
St Mary Medical Center
Outpatient Coder/Abstractor
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4.  RE: Sepsis due to (in) pyelonephritis

Posted 10-16-2017 18:10
Thank you, sure I know that, I've coded for over 25 years, exclusively! I am trying to settle a discussion and have gotten a physician to want me to code the N12 and CDI wants the code since it's a CC in this case. Just wanted to get input from different people. Thanks.

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Dianna Bethany
RHIT, CCS, CDIP, ICD-10 Trainer
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5.  RE: Sepsis due to (in) pyelonephritis

Posted 10-17-2017 09:41
Dear Dianna,

Oh wow!! I am so sorry. I did not get that impression from your post. I hope that you are able to forgive me for this misunderstanding.

With that being said, I went back into the Tabular Index to double check both codes and it seems that both N12 and N16 can be used for your diagnosis. If the CDI is saying that N12 will get you the CC and all the coding rules and guidelines are met, then I would go with the CDI and code N12.

Hope this helps you

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
Outpatient Coder/Abstractor
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6.  RE: Sepsis due to (in) pyelonephritis

Posted 10-19-2017 10:22

Hello,

 

This is what I came up with this case.   When following the index (pyelonephritis in sepsis), it lists A41.9 [N16] in the tabular index.  

 

The CDI is correct that N12 is a CC.    However, the coding index does not arrive at this conclusion – pyelonephritis NOS N12 compared to the more specific diagnoses.

 

Looking at this from MS-DRG perspective:  Since sepsis is the principal diagnosis (I'm assuming in this case), a CC makes no difference on the MS-DRG selection.   Please see the grid below from the 2017 CMS IPPS.    This is my take on it.

 

 

 

Yours truly,

 

Denise Reitmeyer

Denise Reitmeyer, MPH, RHIA, CPC

HIT/Medical Coding Instructor

Fox Valley Technical College

1825 N. Bluemound Drive

Appleton, WI   54912

Office:  920-996-2867

Email:  reitmeye@fvtc.edu

 

Please dispose expired and unused medications properly.  Take to your local police department or ask your pharmacy.  

 

Do not flush into sewer or toss in trash.  Protect our water supply and ecosystem.

 






7.  RE: Sepsis due to (in) pyelonephritis

Posted 10-09-2017 11:58
Interesting question and replies. The question stated Sepsis due to Pyelonephritis. The replies all list the N16 (renal-tubulo-interstitial disorders in diseases classified elsewhere) = Pyelonephritis as due to Sepsis. How can Pyelonephritis be a disorder in a disease classified elsewhere when it caused the Sepsis?

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Linnette Wert RHIT, CCS

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8.  RE: Sepsis due to (in) pyelonephritis

Posted 10-16-2017 18:13
Hi, It's due to or in sepsis, either one. The pyelonephritis is due to the sepsis, therefore, per the index and guidelines in which bracketed diagnoses are secondary, it would be listed second. Thanks

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Dianna Bethany
RHIT, CCS, CDIP, ICD-10 Trainer
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9.  RE: Sepsis due to (in) pyelonephritis

Posted 10-19-2017 07:32
​Hi All,

I recently had a chart with the same issue. I was uncertain whether to use the N12 or N16 but this how I interpreted the manual.

If the sepsis is caused by the pyelonephritis, then N12 should be used followed by the sepsis code but if the if the sepsis is the cause (origin) of the pyelonephritis then the N16 code should be used with the sepsis coded first.

Anyone have other ideas?

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Abigail Buccat
Inpatient Coding
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