As per the National Institute of Health (NIH), around 750, 000 Americans are affected by severe sepsis every year and around 210, 000 of these people die. The major impediment to providing treatment for sepsis is that it is very hard to distinguish the disease in its early stages. However, UC Davis researchers found it is possible to predict the early stages of sepsis with the routine information (blood pressure, respiratory rate, temperature and white blood cell count) from EHRs.
Since it is hard to distinguish sepsis earlier, patients are not often screened for blood lactate levels. As several patients having elevated lactate do not have sepsis, blood test also lacks specificity. Even though early treatment with broad-spectrum antibiotics and intravenous fluids cause better outcomes for sepsis patients, the potential risks associated with such treatments for low-risk patients overshadow their benefits. UC Davis researchers wanted to see whether EHRs can provide a strong foundation for understanding when aggressive diagnosis and treatment are required and when they need to be avoided. In their study, the researchers analyzed the EHRs of 741 patients who suffered from sepsis at UC Davis Medical Center during 2010 and found vital signs combined with serum white blood cell count routinely taken for those patients could accurately predict high lactate levels and sepsis. They also found that the lactate level, blood pressure and respiratory rate can identify whether a patient will die from sepsis.
The researchers defined EHRs as a transformative development for providing health care with enormous potential. They opined that EHR can be used as a decision making tool that identifies the health status and possible outcomes from patient histories instead of a ‘gut-level’ approach in doubtful situations. Since the EHR is based on routine measures, it can be used anywhere. The researchers are currently working on a sepsis-risk algorithm which can be calculated automatically in the EHR.
Even though EHRs are beneficial in predicting sepsis as per the study, several challenges exist with regard to its implementation as the ICD-10 deadline is approaching (October 1, 2014). When ICD-10 comes into effect, there must be a high degree of specificity with EHR documentation. The increased number of codes with ICD-10 divides health conditions and clinical procedures into various classifications according to different clinical criteria such as infectious organism, body part affected and so on. Physicians must document the details of a condition or a procedure accurately with EHR so that it will lead to the assignment of the most specific code and correct reimbursement. For example, you can find two codes for ‘sepsis due to streptococcus’ in ICD-9 medical coding such as:
- 038.0: Streptococcal septicemia
- 038.2: Pneumococcal septicemia (Streptococcus pneumoniae septicemia)
In ICD-10, you can find five codes for the same condition with a variety of specifications:
- A40.0: Sepsis due to streptococcus, group A
- A40.1: Sepsis due to streptococcus, group B
- A40.8: Other streptococcal sepsis
- A40.9: Streptococcal sepsis, unspecified
- A40.3: Sepsis due to Streptococcus pneumoniae
A professional billing and coding company that offers EHR feeds can free physicians from the hassles of revenue management and provide the service of experienced AAPC certified coders to assign the most appropriate ICD-10 codes.
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