Topic: Non-infectious SIRS with organ dysfunction
- 65 year old male admitted with history of alcohol abuse and HTN
- Patient presents with abdominal pain and vomiting for 4 days
- Vital signs in ED: 160/90, HR 120, RR 24, T101.7F
- Labs: WBC 18.0, Lactic Acid 2.6 on admit, repeat in 24 hrs. 2.0, Blood Glucose 250 – no history of Diabetes. BUN 20, Creatinine 2.1 on admit, repeat 1.0 with IVF. Lipase 1182, Amylase 740, Blood Alcohol Level negative, Urinalysis negative, Blood Cultures negative
- Radiology: CT scan shows acute pancreatitis without peritonitis. Chest x ray negative for acute process
- ED physician documents “Acute Pancreatitis, rule out Sepsis”
- Two days later, attending notes “treating Acute Pancreatitis, Sepsis ruled out, no infectious process noted”
- Patient treated with IVF, Morphine PRN for pain, IV Vancomycin – d/c on day 2 due to infection ruled out
Question: Is there a query opportunity based on the scenario stated above?
- Patient was admitted with possible Sepsis which was ruled out. However, patient did meet SIRS criteria with elevated WBC, fever, lactic acidosis, hyperglycemia w/o diabetes, tachycardia, tachypnea. Patient noted with AKI on admission.
- SIRS can be caused by sources other than infection, i.e. Trauma, burns, pancreatitis, major surgery, malignancies, bowel infarction, tumor lysis syndrome, or other injury/insult. (Reference ICD-10-CM Official Guideline I.C.18.g)
“If acute organ dysfunction is documented, but it cannot be determined if the acute organ dysfunction is associated with SIRS or due to another condition (e.g., directly due to trauma), the provider should be queried”
- Query for Non-infectious SIRS related to Acute Pancreatitis and if the AKI is related to Non-infectious SIRS
- R65.11 – Non-infectious SIRS with acute organ dysfunction is an MCC with SOI of 4
- R65.10 – Non-infectious SIRS without organ dysfunction is a CC with SOI 2
CDI Educational Tips: Query indicators in patients meeting SIRS Criteria
- ED has started sepsis work up, e.g. Sepsis 3 protocol – Fluid bolus 30 ml/kg, Lactate levels drawn, blood cultures drawn
- Labs and Imaging all negative for infection
- SIRS criteria present
- Provider has documented infectious process not present or ruled out
- There is no link documented between the non-infectious SIRS and the organ failure
This is a short synopsis of a possible patient record and is not intended to be all inclusive. This is for educational purposes only and not intended to replace your institutional guidelines.