Q:  When a patient has sepsis due to COVID-19, is the sepsis code always sequenced first?
A:  No. Sequencing depends on whether the sepsis was present on admission and meets the definition of principal diagnosis. If a patient presented with a COVID-19 infection and sepsis developed later during the admission, code U07.1 (COVID-19) is sequenced first. If sepsis was due to COVID-19 and was present on admission, sequence the sepsis code first. Refer to the ICD-10-CM Official Guidelines for Coding and Reporting, section I.C.1.g.1.b. and I.C.1.d. for sequencing instructions for COVID-19 and sepsis.

Q:  In the alphabetic index under the main term “Sepsis,” the word “with” is indented immediately under the term with a subterm for “organ dysfunction (acute) (multiple).” Per the guidelines, the word “with” in the index assumes a causal relationship between the two terms. Why must the provider document a link between sepsis and acute organ dysfunction? Can’t this be assumed based on the guideline?
A:  The full guideline I.A.15. “With” reads:

The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).
For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.
The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.
Additionally, guideline I.C.1.d.1.a. states: “A code from subcategory R65.2, Severe sepsis, should not be assigned unless severe sepsis or an associated acute organ dysfunction is documented.” Based on these guidelines, a link between sepsis and acute organ dysfunction must be documented to assign a code for severe sepsis.

Q:  How should community-acquired sepsis be coded for a 2-week-old infant? In the index, newborn sepsis is noted to be congenital.
A:  Assign a code from category P36 for community-acquired sepsis developing within the first 28 days of life. The index entry for newborn sepsis – Sepsis; newborn (congenital) – lists the term “congenital” as a nonessential modifier, meaning that the diagnostic statement may, but does not have to include, that term. Includes notes in the tabular listing for category P36 state that this category includes congenital sepsis, but that does not mean it is all-inclusive. Refer to guidelines I.A.7. and I.A.10. for the use of parentheses and Includes notes in ICD-10-CM.

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Director of Coding Quality & Education

Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.

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