Health Information Management

Prepare for RAC audits by exercising caution with septicemia codes

HIM-HIPAA Insider, April 27, 2010

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Overcoding and coding based on insufficient documentation may be one reason why RACs are auditing these two MS-DRGs, along with many others:

  • 872 (Septicemia without mechanical ventilation 96+ hours without MCC)
  • 871 (Septicemia without mechanical ventilation 96+ hours with MCC)
Before reporting 038.xx, coders must determine whether these signs and symptoms mean that a patient truly has sepsis or septicemia, says Jennifer Avery, CCS, CPC-H, CPC, CPC-I, regulatory specialist at HCPro, Inc., in Marblehead, MA. The patient may have an inflammatory response due to another localized infection and not be sick or in danger of developing sepsis or septicemia, says Avery. When physicians explicitly document only septicemia, coders should query them to determine whether the patient also has sepsis, she says.
 
Editor’s note: For additional tips, see the April issue of Briefings on Coding Compliance Strategies.



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