Q&A: Sequencing sepsis due to infected arteriovenous graft, central venous catheter

Q: What is the coding sequence for sepsis due to infected arteriovenous (AV) graft or central venous catheter?

A: This is a great question. There are a couple of factors that will impact the sequencing. If a patient is admitted with an infected AV graft or central venous catheter (meaning present on admission) and is also diagnosed with sepsis, the complication code for the infected device would sequence as the principal diagnosis, as is advised by Coding Clinic, First Quarter 2019, p. 14 “Dialysis central line catheter Iinfection.”

The present on admission factor for the device infection would determine sequencing if the only identified source of infection is an infected device, graft, or implant present on admission. If the infection from a device is NOT present on admission, and sepsis from another identified source (such as pneumonia) is documented, the sepsis would likely sequence as the principal diagnosis.

Additionally, if the patient has multiple sources of infection, which would include an infected device, graft, or implant AND an additional source of infection such as pneumonia, then Coding Clinic, Third Quarter 2019, p. 17, “Sepsis due to multiple possible causes” says:

When determining the principal diagnosis for a patient with multifactorial sepsis, the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

In the unusual instance when two or more diagnoses equally meet the criteria for principal diagnosis as determined by the circumstances of admission, diagnostic workup and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guideline does not provide sequencing direction, any one of the diagnoses may be sequenced first.

Editor’s note: Kim Conner, BSN, CCDS, CCDS-O, CDI education specialist for ACDIS/HCPro based in Middleton, Massachusetts, answered this question. Contact her at kconner@hcpro.com.