AHA Coding Clinic® for ICD-9 - 2011 Issue 3; Clarifications

Sepsis Due to a Localized Infection

A 45-year-old patient was admitted with mental status changes. She had a long-standing history of methicillin resistant Staphylococcus aureus (MRSA) osteomyelitis of the ankle and end-stage renal failure (ESRD), receiving hemodialysis. Laboratory workup showed a white count of 28,000 and blood cultures positive for MRSA. The provider determined that the patient’s mental status change was due to sepsis and his final diagnostic statement listed, “sepsis secondary to osteomyelitis.” What is the appropriate sequencing of the principal diagnosis, the localized infection (osteomyelitis) or the systemic infection (sepsis)? How are coders to determine whether the localized infection is the underlying cause of the sepsis? ...

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