After reading a recent article in the April 4, 2012 issue of JAMA (Lindauer PK, et al, Association of Diagnostic Coding With Trends in Hospitalizations and Mortality of Patients With Pneumonia, 2003-2009 - http://jama.ama-assn.org/content/307/13/1405.full), I decided to look at my institution's administrative data regarding the number of hospitalizations in the past 4 years that were coded with the ICD9# for either sepsis or severe sepsis as the primary diagnosis. There were none. Zero. I have long suspected that one obstacle to diagnosing sepsis or severe sepsis is that most physicians (and perhaps coders, too) regard it as a secondary diagnosis. That sepsis is always secondary to something else...not a primary diagnosis that represents a final common pathway due to a number of different causes. There are likely a number of other cognitive factors related to the avoidance of diagnosing sepsis and severe sepsis as a primary diagnosis. But evidently physicians & coders at other institutions are doing it. I look forward to your comments.
Regards, Dr. Don Hess
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