What would be the appropriate PDX in the case below?
Scenario: Pt. admitted with sepsis d/t bacteremia and AMI, both present on admission. Both conditions were treated (abx, heart cath – needs PCI after sepsis treated). We used AMI as principal with sepsis as MCC. Coding said that in patient’s with sepsis on admission, sepsis is always used as principal unless HIV, pregnancy, neonate, or device complication. They could not support this rationale with Coding Clinic but said this was according to advice provided by a coding auditing company. Based on coding clinic guidelines, the CDS’ thought AMI could be PDX. Answer: • There is no coding guideline that states sepsis/systemic infection is always the PDX when it is present on admission. There are chapter specific sequencing guidelines for SIRS/sepsis that may require the systemic infection to be sequenced as PDX when due to a local infection. • The AMI could be viewed as an acute organ dysfunction resulting from sepsis—especially if there is an infectious process also present, however the A
