Find information on neutropenic sepsis diagnosis, including clinical documentation requirements, ICD-10 codes (R78.81, J15.21, other sepsis codes), medical coding guidelines, and healthcare best practices for managing febrile neutropenia and sepsis in neutropenic patients. Learn about risk factors, symptoms, treatment, and the importance of accurate documentation for appropriate reimbursement and quality patient care. This resource provides insights for healthcare professionals, coders, and CDI specialists involved in the care of patients with neutropenia and sepsis.
Also known as
Agranulocytosis
Severe neutropenia, a key feature of neutropenic sepsis.
Shock, not elsewhere classified
Sepsis can lead to shock if untreated.
Sepsis
Encompasses various systemic infections, including neutropenic sepsis.
Other specified abnormal findings of blood chemistry
Can be used to specify neutropenia if not coded elsewhere.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the patient neutropenic?
Yes
Is sepsis documented?
No
Do NOT code neutropenic sepsis. Code sepsis and underlying condition separately.
When to use each related code
| Description |
|---|
| Neutropenic sepsis |
| Febrile neutropenia |
| Sepsis |
Coding sepsis without confirming neutropenia leads to inaccurate DRG assignment and potential overpayment.
Lack of documentation specifying the infection source impacts severity coding and reimbursement.
Inconsistent documentation of neutropenia severity affects code selection and accurate reflection of patient acuity.
Q: What are the most effective empiric antibiotic treatment strategies for neutropenic sepsis in adult patients with hematologic malignancies?
A: Empiric antibiotic treatment for neutropenic sepsis in adults with hematologic malignancies must be initiated promptly after blood cultures are drawn. Current guidelines recommend broad-spectrum coverage against gram-negative bacteria, including Pseudomonas aeruginosa, with agents such as cefepime, carbapenems (meropenem, imipenem-cilastatin), or piperacillin-tazobactam. Antistaphylococcal coverage with vancomycin or linezolid should be added if the patient has a central venous catheter, skin or soft tissue infection, or suspected MRSA. Antifungal therapy (e.g., caspofungin, micafungin) should be considered if the patient remains febrile after 4-7 days of broad-spectrum antibiotics. The choice of empiric regimen should be guided by local resistance patterns and patient-specific factors, including allergies and renal function. Explore how our antimicrobial stewardship resources can help optimize antibiotic selection and duration in your practice.
Q: How can I differentiate between febrile neutropenia and neutropenic sepsis in a clinically unstable oncology patient? What are the key clinical indicators to look for?
A: Differentiating between febrile neutropenia and neutropenic sepsis can be challenging, especially in unstable oncology patients. While febrile neutropenia is defined as a single oral temperature of 38.3°C (101°F) or a temperature of 38.0°C (100.4°F) sustained over one hour in a neutropenic patient (absolute neutrophil count < 500/mm3 or <1000/mm3 with predicted decline to <500/mm3 within 48 hours), neutropenic sepsis represents a more serious condition where the infection has progressed to systemic inflammation and organ dysfunction. Key clinical indicators suggesting progression to sepsis include hypotension, tachycardia, tachypnea, altered mental status, and evidence of organ dysfunction (e.g., elevated creatinine, lactic acidosis, disseminated intravascular coagulation). Consider implementing a standardized assessment tool like the quick Sequential Organ Failure Assessment (qSOFA) for early identification and prompt escalation of care in patients with suspected neutropenic sepsis. Learn more about risk stratification strategies for febrile neutropenia.
Patient presents with neutropenic sepsis, likely secondary to [underlying cause, e.g., chemotherapy for acute myeloid leukemia]. The patient exhibits clinical signs and symptoms consistent with systemic inflammatory response syndrome (SIRS) including fever greater than 38 degrees Celsius, heart rate exceeding 90 beats per minute, respiratory rate above 20 breaths per minute, and an absolute neutrophil count (ANC) less than 500 cellsmm3. Blood cultures have been drawn and sent for analysis. Given the patient's immunocompromised state and clinical presentation, broad-spectrum antibiotics, such as [specify antibiotics, e.g., cefepime and vancomycin], have been initiated empirically. The patient is also receiving intravenous fluids for hemodynamic support. Differential diagnosis includes febrile neutropenia, infection-related neutropenia, and sepsis-induced neutropenia. Monitoring will include serial complete blood counts (CBCs) with differential, blood cultures, lactate levels, and vital signs. Further investigations may be warranted depending on culture results and clinical response to treatment. ICD-10 code D70.8 (Neutropenia) and R57.8 (Other fever) are provisionally documented, with potential for refinement to sepsis codes (A40-A41) based on culture confirmation. This documentation supports medical necessity for hospital admission and ongoing antibiotic therapy. The patient's prognosis is dependent on the source and severity of infection, response to therapy, and underlying medical conditions. Continued vigilance for signs of clinical deterioration is essential.