Coding, Classification & Reimbursement

Postpartum UTI with sepsis, Excludes 1

  • 1.  Postpartum UTI with sepsis, Excludes 1

    Posted 05-10-2019 10:32
    ​Patient delivered 1 week prior, now presents with E coli UTI and sepsis.  O85 (Postpartum sepsis) has an Excludes 1 for urinary tract infection following delivery (O86.2-).  How would you code this visit?

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    Christine Crockford
    Coding Reviewer

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  • 2.  RE: Postpartum UTI with sepsis, Excludes 1

    Posted 05-15-2019 12:52

    I am please asking for feedback regarding if my understanding of the Excludes 1 note is correct.  3M encoder results take you to the code in the Excludes 1 note.  AHA Coding Clinic 4th Q 2018 Pages:  87-88 just recently answered specifically to assign only the code referenced in the Excludes1 note. However, Coding Clinic's answer to 2nd Q 2018 Page:  9 Carotid artery stenosis and transient ischemic attack is contradictory to Coding Clinic 4th Q 2018 Pages:  87-88 Excludes1 Instruction Note.

    In ICD 9 CM  670.24 (Postpartum sepsis) and 646.64 (Infections of genitourinary tract in pregnancy) were mutually exclusive.  In I-10 there is an Excludes1 instruction note urinary tract infection following delivery (O86.2-) on code O85 (Postpartum sepsis).  Per Excludes1 instruction note, I interpret only O86.2- is assigned, no code for postpartum sepsis.  I'm thinking there should either be also an Excludes1 note for code O86.2-), or the Excludes1 note for O85 should be changed to an Excludes 2 note.

    Also of note - Cardiac arrest (I46.-) has an Excludes1 instruction note for Cardiogenic shock (R57.0).  Therefore, only cardiac arrest (I46.-) is assigned, no code for cardiac arrest?

    ICD-10-CM Official Guidelines for Coding and Reporting

    Excludes1

    A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

    An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider.

    Puerperal sepsis (postpartum)

    Code O85, Puerperal sepsis, should be assigned with a secondary code to identify the causal organism (e.g., for a bacterial infection, assign a code from category B95-B96, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction.

     




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    Christine Crockford
    Coding Reviewer

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  • 3.  RE: Postpartum UTI with sepsis, Excludes 1

    Posted 05-17-2019 19:12
    Edited by Laurie Zawiskie 05-18-2019 09:04
    Christine,

    This is very interesting . I don't see a lot of postpartum accounts, so I haven't coded this scenario before. I ran it through the 3M encoder today and it only coded 086.20 (UTI following delivery). This is consistent with the Excludes1 note. It seem odd that you wouldn't code the sepsis, but I think we have no other option at this time.

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    Laurie Zawiskie
    Coder III
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