Sepsis sequencing FAQs
Q A
: I’m a bit confused by sepsis sequencing. Should it always be coded as the principal diagnosis, or are there instances where it wouldn’t be principal? : If sepsis is present on admission (POA), sepsis (the systemic illness) is coded first, followed by severe sepsis (and septic shock) if present, followed by the local infection. According to the Official Guidelines for Coding and Reporting, if sepsis was POA, it will almost always be your principal diagnosis, except in instances specified in the code set. If sepsis is not POA, it cannot be coded as principal diagnosis. Remember the definition of principal diagnosis: “the condition which, after study, was found to have occasioned the admission.” The sepsis could not have occasioned the admission unless it was present when the admission order occurred. Q: If a patient was admitted with pneumonia and sepsis, I would sequence the sepsis as principal, right? A: Correct. Since the sepsis was POA and it was the systemic
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infection, it will be sequenced first, followed by the pneumonia. Q: What about if the pneumonia is HIV-associated and the patient was admitted with sepsis? Would the HIV be the principal diagnosis, or would the sepsis be principal? A: In most cases the HIV would be coded as the principal diagnosis, unless the provider indicated that the sepsis/infection was not related to the HIV disease, but that would be very rare. Take a look at p. 19 of the Official Guidelines for Coding and Reporting: 2) Selection and sequencing of HIV codes (a) Patient admitted for HIV-related condition: If a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease followed by additional diagnosis codes for all reported HIV-related conditions. (b) Patient with HIV disease admitted for unrelated condition: If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (e.g., the nature of injury code) should be the
principal diagnosis. Other diagnoses would be B20 followed by additional diagnosis codes for all reported HIV-related conditions. Q: What about if the patient was admitted with a urinary tract infection (UTI) and sepsis? Would the sepsis still be the principal diagnosis? If the patient had a chronic Foley catheter and developed a catheter-associated UTI (CAUTI) with sepsis, would the CAUTI be the principal diagnosis, or would it be the sepsis? A: In the first instance, when the patient was admitted with a UTI and sepsis, sepsis would be the principal diagnosis as long as it was also POA. In the second instance, the complication code for the CAUTI (T83.511A) would be the principal diagnosis, followed by the code for the sepsis. If the sepsis is identified as a complication related to an implanted device or medical intervention, the complication would always be sequenced first, followed by the sepsis. Take a look at p. 24 of the Official Guidelines for Coding and Reporting: 5) Sepsis due to a postprocedural infection
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