AHA Coding Clinic® for ICD-9 - 2005 Issue 2; Ask the Editor

Septic Shock, Respiratory Failure and Pneumonia

The patient is an 85-year-old female who presents to the emergency department (ED) with increasing shortness of breath, productive cough and progressive weakness. She acutely deteriorated in the ED and was emergently sent to the intensive care unit (ICU). In the ICU, the patient was intubated, mechanically ventilated and started on broad-spectrum antibiotics for septic shock, respiratory failure and Haemophilus influenza pneumonia. The patient then suffered an acute nontransmural myocardial infarction (MI). Some of the coders feel that the pneumonia should be sequenced as the principal diagnosis. However, the Official Guidelines for Coding and Reporting of septicemia, SIRS, sepsis, severe sepsis and septic shock previously published in Coding Clinic First Quarter 2005, pages 36-40 state, “Septic shock is a from of organ dysfunction associated with severe sepsis. A code for the initiating underlying systemic infection followed by a code for SIRS (code 995.92) must be assigned before the code for septic shock. As noted in the sequencing instructions in the Tabular List, the code for septic shock cannot be assigned as a principal diagnosis.” How should this case be coded? ...

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