Documentation issues: Often, a patient with a localized infection may exhibit tachycardia, leukocytosis, tachypnea, and fever, but not truly have SIRS or sepsis. These are typical symptoms of any infection.
SIRS is manifested by two or more of the following symptoms: fever, tachycardia, tachypnea, leukocytosis, or leukopenia. Documentation issues: When SIRS is documented on the chart, determine if it’s due to an infectious or non-infectious cause. SIRS due to a localized infection can no longer be coded as sepsis in.
Codes from category P36 include the organism; an additional code for the infectious organism is not assigned. If the P36 code does not describe the specific organism, an additional code for the organism can be assigned. Urosepsis. The term “urosepsis” is not coded in ICD-10-CM.
Adult patients frequently present to the physician's office with a fever (temperature higher than 38.3°C [100.9°F]). 1 Most febrile conditions are readily diagnosed on the basis of presenting symptoms and a problem-focused physical examination.
Of the many infectious diseases that are associated with FUO, tuberculosis (especially in extrapulmonary sites) and abdominal or pelvic abscesses are the most common. 13 Intraabdominal abscesses are associated with perforated hollow viscera (as occurs in appendicitis), diverticulitis, malignancy, and trauma. Other common infections that should be considered as the source of FUO include subacute bacterial endocarditis, sinusitis, osteomyelitis, and dental abscess. 11, 13 As the duration of fever increases, the likelihood of an infectious etiology decreases. Malignancy and factitious fever are more common diagnostic considerations in patients with prolonged FUO. 14
Nosocomial FUO is defined as fever occurring on several occasions in a patient who has been hospitalized for at least 24 hours and has not manifested an obvious source of infection that could have been present before admission. A minimum of three days of evaluation without establishing the cause of fever is required to make this diagnosis. 5 Conditions causing nosocomial FUO include septic thrombophlebitis, pulmonary embolism, Clostridium difficile enterocolitis, and drug-induced fever. In patients with nasogastric or nasotracheal tubes, sinusitis also may be a cause. 7, 8
HIV-associated FUO is defined as recurrent fevers over a four-week period in an outpatient or for three days in a hospitalized patient with HIV infection. 5 Although acute HIV infection remains an important cause of classic FUO, the virus also makes patients susceptible to opportunistic infections. The differential diagnosis of FUO in patients who are HIV positive includes infectious etiologies such as Mycobacterium avium-intracellulare complex, Pneumocystis carinii pneumonia, and cytomegalovirus. Geographic considerations are especially important in determining the etiology of FUO in patients with HIV. For example, a patient with HIV who lives in the southwest United States is more susceptible to coccidioidomycosis. In patients with HIV infection, non-infectious causes of FUO are less common and include lymphomas, Kaposi's sarcoma, and drug-induced fever. 9, 10
Complications from cirrhosis and hepatitis (alcoholic, granulomatous, or lupoid) are also potential causes of FUO. 12, 13 Deep venous thrombosis, although a rare cause of FUO, must be considered in relevant patients, and venous Doppler studies should be obtained. 17 Factitious fever has been associated with patients who have some medical training or experience and a fever persisting longer than six months. 18 Failure to reach a definitive diagnosis in patients presenting with FUO is not uncommon; 20 percent of cases remain undiagnosed. Even if an extensive investigation does not identify a cause for FUO, these patients generally have a favorable outcome. 19
HIV-associated FUO is defined as recurrent fevers over a four-week period in an outpatient or for three days in a hospitalized patient with HIV infection. 5 Although acute HIV infection remains an important cause of classic FUO, the virus also makes patients susceptible to opportunistic infections.