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
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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.
Denise Reitmeyer, MPH, RHIA, CPC
HIT/Medical Coding Instructor
Fox Valley Technical College
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