Medical Coding Simplified

Small differences in sepsis and SIRS guidelines can result in major differences in reimbursement. Sepsis, systemic inflammatory response syndrome (SIRS), and septicemia have historically been difficult to code. ICD-10-CM has introduced lots of changes to sepsis and SIRS coding. It’s critical to code sepsis properly due to the impact the diagnosis has on reimbursement. For example, consider the following case study: A 39-year-old patient was admitted with the diagnosis of community-acquired pneumonia in the setting of presumptive influenza and concurrent sepsis. In the history and physical exam, it was documented that the patient had sepsis and SIRS, meeting the criteria of leukocytosis, fever, and tachypnea, with pneumonia as the source. The sputum culture was positive for pseudomonas pneumonia. The patient had a six-day stay. The discharge diagnoses were influenza with pneumonia bacterial superinfection, positive for pseudomonas, as well as acidosis, asthma exacerbation, hyp

·          Redaction  – Editing a document and removing some details before publishing ·          Aliquot - A weighable quantity of drug is dissolved in a calculated volume of a suitable solvent, usually water or ethanol. Then, an aliquot of the solution containing the desired amount of drug is removed ·          Arthrodesis – Fusion of a joint ·          Carte Blanche – Unconditional authority ·          Nomenclature - the body or system of names used in a particular specialist field. ·          Standby - readiness for duty or immediate deployment. ·          Moribund – at the point of death ·          Physiological - Normal function of a living organism ·          Therapeutic – healing of a disease ·          Cephalic – Towards the head ·          Caudad – towards the tail ·          Percutaneous – Through the skin ·          Pathology – Study of disease ·          Benign – Harmless ·          Malignant – Invasive, dangerous ·          Viscera -