2025 ICD-10-CM code A40.3
Sepsis due to Streptococcus pneumoniae (pneumococcal sepsis).
Medical necessity hinges on the documented presence of sepsis as a direct result of the Streptococcus pneumoniae infection.The severity of the sepsis and the need for interventions like antibiotics, fluids, or other supportive care should be clearly justified based on the patient's clinical condition.
Clinicians should diagnose based on patient history, physical exam, and laboratory tests identifying Streptococcus pneumoniae in blood, urine, or other samples. Treatment typically involves antibiotics and supportive care (e.g., fluids, oxygen), sometimes dialysis or surgery. Patient education on hygiene and vaccination may also be part of clinical responsibility.
In simple words: Sepsis due to Streptococcus pneumoniae is blood poisoning caused by this common bacteria.It's a serious situation where an infection, often starting in the nose or throat, spreads throughout the body, causing a dangerous inflammatory reaction.
A systemic inflammatory response syndrome (SIRS) resulting from a documented infection with Streptococcus pneumoniae.This condition represents a severe and potentially life-threatening complication where the infection has spread to the bloodstream.
Example 1: A patient presents with fever, chills, rapid heart rate, and low blood pressure after a recent pneumonia diagnosis. Blood cultures confirm Streptococcus pneumoniae, indicating sepsis., An elderly patient with a history of sinus infection develops confusion, shortness of breath, and unstable vital signs.Streptococcus pneumoniae is found in their bloodstream, signifying the onset of sepsis., A child with an ear infection develops high fever, lethargy, and poor perfusion. Blood tests reveal Streptococcus pneumoniae, confirming sepsis as a complication.
Documentation should include evidence of infection (e.g., positive culture, clinical findings), the presence of SIRS criteria, and confirmation of Streptococcus pneumoniae as the causative organism. Organ dysfunction details are also crucial.
** Excludes: neonatal sepsis (P36.0-P36.1), puerperal sepsis (O85), and sepsis following procedures (T81.44-), central venous catheter (T80.211-), or specific obstetric complications (O03.37, O03.87, O04.87, O07.37, O08.82, O75.3).
- Specialties:Infectious Disease, Critical Care, Internal Medicine, Family Medicine, Pediatrics, Emergency Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office, Skilled Nursing Facility, Nursing Facility