ICD-10 Coding for History of Sepsis(Z86.04)
Complete ICD-10-CM coding and documentation guide for History of Sepsis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Sepsis
Z86-Z87Primary Range
Personal history of certain other diseases
This range includes codes for personal history of diseases, including sepsis.
Key Information: ICD-10 code for history of sepsis
Essential facts and insights about History of Sepsis
Primary ICD-10-CM Code for history of sepsis
Decision Criteria
documentation Criteria
- Sepsis episode must be documented as resolved with a specific date.
Applicable To
- Resolved sepsis
- Past sepsis episode
Excludes
- Current sepsis (A41.9)
Clinical Validation Requirements
- Documented resolution of sepsis
- Date of past sepsis episode
- No current signs of infection
Code-Specific Risks
- Misclassification as current sepsis
- Omission of resolution status
Coding Notes
- Ensure documentation clearly states the sepsis is resolved and provides context.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Bacterial and viral infectious agents
B95-B97Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Sepsis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z86.04.
Impact
Clinical: Misleading clinical picture of the patient's health., Regulatory: Potential audit triggers., Financial: Incorrect billing and reimbursement.
Mitigation Strategy
Always verify historical conditions are documented as resolved., Educate providers on documentation standards.
Impact
Reimbursement: Incorrect DRG assignment leading to potential overpayment., Compliance: Risk of audit and compliance issues., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Verify documentation for resolution status and use Z86.04 for historical cases.
Impact
Confusion between coding for historical and active sepsis.
Mitigation Strategy
Ensure clear documentation of resolution and historical context.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Sepsis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Sepsis
Use these documentation templates to ensure complete and accurate documentation for History of Sepsis. These templates include all required elements for proper coding and billing.
Patient with past sepsis episode
Specialty: Internal MedicineRequired Elements
- Resolution status
- Date of past sepsis
- No current infection signs
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for History of Sepsis? Ask your questions below.