As we adjust to the new normal for the month, our ECLAT experts are delighted to share some helpful tips for selecting the correct code assignment when it comes to septic emboli. But first, let's refresh your memory by describing the clinical criteria.
A septic embolus is a type of bacterial infection inside a blood vessel due to a thrombus or fat globule or air or foreign material. This term specifically refers to an infection that started in one part of the body and travelled through blood vessels to reach another part of the body, possibly blocking one or more blood vessels.
There are 2 Types of Septic Embolisms:
Note: To make sure if the patient has a septic arterial or septic pulmonary embolism, the location of the embolism, and the embolus must be documented as septic.
- Arterial: A septic arterial embolus may originate from a central infection, such as in the heart and then travel through the systemic arterial system to lodge in small vessels anywhere in the body, such as the brain, the retina, or the digits. It can block a blood vessel in the brain, causing a stroke, transient ischemic attack (TIA), cerebral hemorrhage, meningitis, brain abscess, or a mycotic aneurysm.
- Pulmonary: A septic pulmonary embolus originates from a localized infection such as a localized cellulitis or a central venous catheter infection. The embolic material travels through the venous system to the right side of the heart and goes into the pulmonary arterial system where it lodges in small vessels.
Septic pulmonary emboli may cause subsequent lung abscess or necrotizing pneumonia. Multiple peripheral nodular lung infiltrates and cavitary lesions may be seen on CT of the chest.
When the diagnosis is confirmed, antibiotic therapy is used to manage the infection with thrombolytic treatment of the embolus. Depending on the cause of the septic pulmonary embolic, treatment with anticoagulants may be considered.
Note: Do not Sequence Embolism as Primary Diagnosis (pdx)
Whether reporting septic arterial or septic pulmonary embolisms, you should never report these codes as the primary diagnosis. Instead, septic embolism codes come with the instructions to "code first the underlying infection.”
3 Tips to keep in mind when reporting diagnosis codes, like septic embolisms:
Always read the coding notes. For example, with both septic pulmonary and arterial embolisms, you have the note: "Code first underlying infection.”
Check to see if there is an "use additional code” note. This means you must report a second code in conjunction with the first code. E.g. a note with I76 tells you to "use additional code to identify the site of the embolism (I74- Arterial embolism and thrombosis)".
Watch out for "Excludes” notes.
Now, let's review with some examples.
Septic pulmonary embolism example 1:
The hospital admits a 46-year-old chain smoker with fever, shortness of breath, and pulmonary infiltrates. Staphylococcus aureus is cultured from the blood, and the pulmonologist diagnoses tricuspid endocarditis. The attending documents staphylococcal septicemia due to bacterial endocarditis and septic pulmonary emboli.
A41.01 for the staphylococcal septicemia as primary diagnosis (pdx)
I33.0 (Acute and subacute infective endocarditis) for acute bacterial endocarditis
I26.90 for septic pulmonary emboli.
Septic arterial embolism example 2:
The physician diagnoses the patient with septic arterial embolism. His underlying infection is acute infective endocarditis. Also, according to the documentation, the patient has an embolism and thrombosis of the thoracic aorta.
I33.0 (Acute and subacute infective endocarditis) as the primary diagnosis (pdx)
I76 as the secondary diagnosis.
Per coding instructions, you would also report the following:
I74.11 (Embolism and thrombosis of thoracic aorta) to identify the site of the embolism.