Q&A: When sepsis isn’t the principal diagnosis

Q: We recently had a patient who was admitted with sepsis present on admission (POA) and a urinary tract infection (UTI). When the chart was coded, UTI was listed as the principal diagnosis. I was under the impression that when sepsis is POA, it should always be coded as the principal diagnosis. Is that correct? When wouldn’t sepsis POA be principal?

A: Likely, in the case you describe, the patient had sepsis that was due to a catheter-associated UTI (CAUTI). There are in fact some instances where sepsis may be present, but not selected as the principle diagnosis. One such example is when the sepsis was not POA.

Other instances when sepsis would not be selected as the principal diagnosis, even if it was POA include the scenario where sepsis is the result of a condition which is classified as a “medical complication” (such as being due to an indwelling urinary catheter or central line.

The answer is in the Official Guidelines for Coding and Reporting, Section I.C.d.5.b:

(b) Sepsis due to a post procedural infection. For such cases, the post procedural infection code, such as T80.2, Infections following infusion, transfusion, and therapeutic injection, T81.4, Infection following a procedure, T88.0, Infection following immunization, or O86.0, Infection of obstetric surgical wound, should be coded first, followed by the code for the specific infection.

In this case, the CAUTI falls into the category of “post procedural infection” and is assigned ICD-10 code T83.51, Infection and inflammatory reaction due to indwelling urinary catheter. Under ICD-10 rules and conventions, the CAUTI is required to be sequenced as the principal diagnosis over the ICD 10 code for sepsis, A41. x.

 Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for HCPro in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.