Cellulitis, UTI & Sepsis

According to the Centers for Disease Control and Prevention (CDC), cellulitis is a common bacterial skin infection. If untreated, it can spread to other tissues and organs. As a result, patients may develop sepsis, suppurative arthritis, osteomyelitis, and endocarditis, among other serious health complications.

Clinical Documentation

• Location

• Infectious

• Risk factors like injuries, chronic skin conditions, edema, obesity, and others.

ICD-10-CM coding

This is a limited list, see the codebook for more options.

• L03.011, Cellulitis of right finger

• L03.012, Cellulitis of left finger

• L03.111, Cellulitis of right axilla

• L03.112, Cellulitis of left axilla

• L03.115, Cellulitis of right lower limb

• L03.116, Cellulitis of left lower limb

• L03.211, Cellulitis of face

• L03.311, Cellulitis of abdominal wall

Use an additional code from categories B95-B97 to specify infectious agent, e.g., group A strep

• L03.312, Cellulitis of back

• L03.313, Cellulitis of chest wall

• L03.314, Cellulitis of groin

• L03.315, Cellulitis of perineum

• L03.317, Cellulitis of buttock

• L03.811, Cellulitis of head

• L03.90, Cellulitis, unspecified

Cellulitis in the risk adjustment methodology

The skin infection per se does not impact the methodology. However, its potential complications such as sepsis and osteomyelitis do.

Urinary Tract Infection (UTI)

UTIs are common infections when bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract. UTI is a general term used to encompass infections in different locations in the urinary system; however, the most common site is the bladder (cystitis).

Clinical Documentation

• Location

• Infectious

• Risk factors like previous infections, pregnancy, enlarged prostate, and others.

ICD-10-CM coding

This is a limited list, see the codebook for more options.

Use an additional code from categories B95-B97 to specify infectious agent, e.g., E. Coli

• N30.00, Acute cystitis without hematuria

• N30.10, Interstitial cystitis (chronic) without hematuria

• N34.2, Other urethritis

• N39.0 Urinary tract infection, site not specified

UTIs do not have an impact on the risk adjustment methodology

According to CDC, sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency managed and treated in a facility setting. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Sepsis can rapidly lead to tissue damage, organ failure, and death without timely treatment. This direr stage is called severe sepsis. However, the most stringent level of sepsis is a septic shock which is diagnosed when the patient suffers from hypotension (Sepsis Alliance, 2022)

Bacterial infections are the most common cause, but other infections can also cause sepsis, such as COVID-19 and influenza. The infections are often in the lungs, stomach, kidneys, or bladder. Sepsis can begin with a small cut that gets infected or an infection that develops after surgery. Sometimes, sepsis can occur in people who did not even know that they had an infection (NIH, 2022).

The minimum clinical documentation requirements for ICD-10-CM code assignment:

• The term “sepsis”

• The infectious organism

• Whether it is severe, including organ dysfunctions

• And whether the patient is suffering from a septic

Who is at risk?

• Adults 65 or older

• People with chronic conditions suchs as diabetes, lung disease, cancer, and kidney disease

• Sepsis survivors

Common infective organisms that cause sepsis are escherichia coli and klebsiella pneumoniae. However, the deadliest is methicillin-resistant staphylococcus aureus.

General coding guidelines

If the type of causal organism is not specified in the documentation, the coder should use code A41.9, Sepsis, unspecified organism. For severe sepsis, at least two codes are required:

• Code identifying the infection, the sepsis per se. Use code A41.9 if the organism is not specified.

• Code R65.20, classifying sepsis as a severe process. However, if the patient is in a septic shock, code R65.21 should be used instead.

• Code associated organ dysfunctions such as acute kidney, respiratory or heart failures

Sepsis in the risk adjustment methodology

All types of sepsis impact the methodology and are classified under the hierarchy (HCC) 2**. The HCC 2 has a score of 0.352.

• Most related organ dysfunctions like acute kidney failure and acute respiratory failure also impact the methodology.

Coding example

A patient with chronic cystitis with hematuria is admitted due to severe sepsis. The organism responsible for the infection is escherichia coli. The patient suffered from acute renal and liver failures during the hospital stay. In addition, the patient has diabetes complicated with chronic kidney disease stage 4 and a history of recurrent UTIs.

• A41.51, Sepsis due to Escherichia coli [E. coli]

• R65.20, Severe sepsis without septic shock

• N17.9, Acute kidney failure, unspecified

• K72.00, Acute and subacute hepatic failure without coma

• E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease

• N18.4 Chronic kidney disease, stage 4 (severe)

• N30.21 Other chronic cystitis with hematuria

• Z87.440 Personal history of urinary (tract) infections

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care.

** CMS-HCC scores are based on CMS’ 2020 community-nondual-aged enrollees.

• CDC, 2022.

- Cellulitis, https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html#:~:text=Cellulitis%20is%20a%20common%20bacterial,Many%20Bacteria%20Can%20Cause%20Cellulitis - Sepsis, https://www.cdc.gov/sepsis/what-is-sepsis.html#:~:text=Sepsis%20is%20the%20body’s%20extreme,%2C%20skin%2C%20or%20gastrointestinal%20tract - UTI, https://www.cdc.gov/antibiotic-use/uti.html#:~:text=UTIs%20are%20common%20infections%20that,is%20another%20type%20of%20UTI

• NIH, 2022. https://medlineplus.gov/sepsis.html

• Sepsis Alliance, 2022. https://www.sepsis.org/sepsis-basics/what-is-sepsis/ 2 of 2