News: CDC proposes sepsis coding changes, requests feedback

The Centers for Disease Control and Prevention (CDC) released a proposal for changes to ICD-10-CM sepsis related codes after receiving numerous questions and comments about the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) published in 2016.

Currently, ICD-10 classifies sepsis as a condition due to bacteria. Sepsis can, however, also be due to viruses, fungi, or protozoa. Because of advances in pathobiology, the CDC felt the need to reexamine the definitions and classifications of sepsis.

New sepsis definitions put forth by the CDC proposal include:

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• Septic shock is a subset of sepsis in which profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality and than with sepsis alone.

In light of the definition changes, the CDC proposal would change the following codes:

• A41, Other bacterial sepsis: Adds the term “bacterial” to the title
• R57, Shock, not otherwise classified: Adds codes for septic shock to this category
• R65.2, Severe sepsis, R65.20-21, Severe sepsis with and without septic shock, and R65.11, SIRS of non-infectious origin with acute organ dysfunction: Deletes these codes all together

In developing the proposal, the CDC considered the following points:

• There is international agreement on the definition of sepsis although there are still ongoing discussions related to the clinical criteria and its applicability in low resource countries.
• Systemic Inflammatory Response Syndrome (SIRS) is no longer the defining criteria of sepsis as a patient can have a life-threatening condition without SIRS, and a non-life-threatening condition with SIRS.
• SIRS can result from a non-infectious origin, so a unique code is needed. Many patients suffer from SIRS after surgery.
• Inconsistent use of terminology in relation to sepsis has created difficulties in coding and inconsistent data has resulted.
• It is not always possible to identify the infectious agent, so there will always be a need to classify sepsis, unspecified.

The CDC is asking for those healthcare professionals to read the proposal and then provide them with any feedback. Additionally, following the September 10-11, ICD-10 Coordination and Maintenance Committee meetings, CMS and the National Center for Health Statistics are requesting feedback on the proposed changes by November 8. Comments on procedure code topics should be sent to ICDProcedurecoderequest@cms.hhs.gov; comments on diagnosis codes should be sent to nchsicd10cm@cdc.gov.

Editor’s note: To read the full CDC proposal, click here. For further information about sepsis history and definitions, click here. To read a commentary on the proposed changes from ACDIS Advisory Board Member Erica Remer, MD, FACEP, CCDS, published in the ICD-10 Monitor, click here.