Coding, Classification & Reimbursement

Bacteremia

  • 1.  Bacteremia

    Posted 05-17-2019 14:22
    ​What ICD 10 code would you use for bacteremia due to MRSA.?  The order has a code of R78.81 (bacteremia).

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    Cheryl Ervin
    Health Information Services
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  • 2.  RE: Bacteremia

    Posted 30 days ago
    That is the only code bacteremia in ICD-10-CM.  The only way that I am aware to pick up the MRSA would be with B95.62 MRSA infection as the cause of diseases classified elsewherer - but bacteremia is not a disease it is an abnormal lab finding.

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    Kathy Completa
    Coding and Documentation Educator
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  • 3.  RE: Bacteremia

    Posted 21 days ago
    ​Bacteremia R78.81 and MRSA B95.62. Agree with the fact that bacteremia is an abnormal finding, so if assigning as potential PDx, I would review for potential Query opportunity.

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    Stacy Strozier, RHIA
    Coder/Auditor/Educator
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  • 4.  RE: Bacteremia

    Posted 9 days ago
    Edited by Andrea Wong 9 days ago
    Generally, bacteremia is coded using one code regardless of the micro-organism to R78.81. Be aware that there is an exclude 1 note for sepsis under R78.81.

    There is a definition in the tabular under R78.81: "Laboratory finding of bacteria in the blood in the absence of two or more signs of sepsis. Transient in nature, it can progress to septicemia with a severe infectious process." If sepsis is documented elsewhere in the record, you would not code the bacteremia.

    I agree that B95-B97 categories are only for documented infections only. It would be inappropriate to use those in addition to R78.81 because it is a symptom code, and not an "infection in diseases classified elsewhere" per the tabular category note.

    If you are coding inpatient encounter, a query may be done if there are at least 2 clinical indicators for sepsis, and there is evaluation, treatment, workup by consultants or attending, etc. The sepsis systemic response is characterized by changes in body temperature, heart rate, respiratory rate, arterial blood gasses, and white blood cell count. Two or more of these indicators and a suspected or known localized infection may indicate sepsis. If there isn't much evaluation or treatment, etc, it could just be an incidental finding and not clinically significant, and so a query wouldn't be warranted.

    If its for an order for OP ancillary encounter for blood draw, then I wouldn't query, and I'd code it as R78.81.

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    Andrea Wong
    Coder
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  • 5.  RE: Bacteremia

    Posted 8 days ago
    ​If the provider has identified a specific organism, but there is no indication of sepsis - there is no instruction in ICD-10 that precludes the assignment of an organism code.  It some cases, the bacteremia may be a secondary diagnosis in association with an infection, such as cellulitis in which the organism code is identified and assigned the appropriate code.

    The presence of specific bacteria in the setting of bacteremia is significant in the study of disease - such as this study regarding dialysis access sites in HD patients:

    CONCLUSIONS:

    The frequency and type of positive blood culture in HD patients are highly associated with type of access used. The high rate of CNS bacteremia with CVC in conjunction with low ESI rate suggests that contamination at the time of accessing the catheter may be the problem. Staff training was followed by a decrease in infection rates. Trending organism-specific bacteremia infection rates in HD units may provide important clues to bacteremia causality and thus prevention.

    Just my thoughts on the subject.



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    Susan Roehl
    Consultant
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  • 6.  RE: Bacteremia

    Posted 7 days ago
    I would be extremely careful on Querying a physician for sepsis based on just two indicators for sepsis.

    The MD should not be queried for Sepsis based on two indicators, usually an elevated WBC and/or fever with Tachy as this indicates a localized infection with SIRS. Also, the indicators should not be easily explained by another co-existing condition (i.e. tachy is commonly caused by pain and/or respiratory conditions, or elevated WBC could be due to steroids). The dx of SIRS is inherent in an infection.

    Alternatively, Sepsis is a severe systemic infection and the patient will look very ill and have a constellation of dysregulation of several organ functions - some "clues" would be elevated Bands in the CBC, elevated lactic acid 2.4 or above (LA 4 indicates possible shock), AMS, lethargy and weakness, coagulopathy, hyperglycemia, high fever, chills, rigors, hypothermia, hypotension, organ failure, immunocompromised. When a Physician documents that the pt looks well or is non-toxic they do not have sepsis.  Coders must remember that it is not one or two clinical indicators that support sepsis but the total clinical picture of the patient's condition.

    RAC auditors look for exactly this type of situation. Erica E. Remer, MD, FACEP, CCDS also writes about how diagnosing sepsis has become so convoluted in her ACDIS article of January 29, 2019 Payers and Clinicians Should use Clinically Accepted Criteria when Diagnosing Sepsis at https://www.icd10monitor.com/payers-and-clinicians-should-use-clinically-accepted-criteria-when-diagnosing-sepsis?utm_campaign=EIENEWS01291%E2%80%A6.  It is very enlightening and worth a read.

    She states:  "The problem was that Sepsis-2 was misinterpreted and misunderstood. It was never intended that the general variable SIRS clinical indicators (temperature, heart rate, tachypnea) plus the inflammatory variable of abnormal WBC count were to be sufficient to diagnose sepsis (I will designate this subset of the greater set of SIRS variables as SIRS). Somewhere along the line, clinicians forgot that sepsis mandated that the patient was sick with a capital "S" from an infection, not just that they were tachycardic and febrile, with a bump in their white blood cell count. SIRS cast a wide net; providers were supposed to sort through the fish and toss the small fries back in the pond."


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    Deborah Simmons, CCS, CCDS,CPC, CHISP
    Approved ICD-10-CM/PCS Trainer
    HIM Sr. Consultant
    Jzanus Consulting, Inc
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  • 7.  RE: Bacteremia

    Posted 7 days ago
    Andrea has provided an excellent reply to this question, and I agree.  There was an instructional note with ICD-9-CM code 790.7, Bacteremia, to use an additional code from ICD-9-CM category 041 to report the organism.  That is why it was coded in ICD-9-CM. No such note exists in ICD-10-CM.

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    Judy Bielby
    Consultant and educator
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