Item 40. Early Sepsis and/or Meningitis (on or before Day 3)

Q: If a baby has a positive culture for Coagulase negative Staphylococci on day 1, 2, or 2 of life, does this qualify as Early Sepsis?

A: No, Coagulase Negative Staphylococci diagnosed on day 1, 2, or 3 of life , does not qualify as Early Sepsis because it is not included as a bacterial pathogen in Appendix C. Also, Coagulase Negative Staphylococci infections are not tracked in our system if they occur on or before day 3 of life.

Item 40-42  Post-Delivery Diagnoses and Interventions - Infections

Q: Need guidance.  I have a patient (infant ID 02614) who was born with a congenital infection (Streptococcus Gallolyticus) but it's not one of the pathogens I can select and there's no other box for me to type in the pathogen.  I don't want to select unknown because I obviously know what it is.  Please advise.  

A: No is the correct answer. That’s a common commensal, not a true pathogen.

Item 41a. Late Sepsis/Meningitis (After Day 3)

Q: What is considered Late Sepsis?

A: Late Sepsis is a positive blood culture that occurs ON or AFTER day 4. Indicate if infant had sepsis ON or AFTER Day 4 by answering each of the 3 parts of the question. If baby died or was discharged on day 1, 2, or 3 or if the infant was discharged prior to day 4, check "N/A".

Q: A 2-3 week old baby that developed clinical signs and symptoms of late onset infection including septic shock. Blood cultures were negative. The tracheal culture grew Staphylococcus aureus (methycilin resistant) and the pleural fluid grew Stapholococcus aureus (methycilin resistant). The clinical course was totally compatible with toxic shock syndrome with regional loss of tissue in a dermatone distribution that eventually required surgical interventions. In the absence of a positive blood culture for Staphylococcus aureus, would this infant qualify for late sepsis?

A: No, since the infant was diagnosed based on the pleural fluid and not blood or cerebrospinal fluid, the infant is not eligible.

Q: a 25-week premature infant is born with clinical signs of septic shock, DIC, thrombocytopenia, respiratory distress. Blood culture was negative, but the tracheal culture taken immediately after birth and before antibiotics was started grew Group B Streptococcus. In the absence of a positive culture for Group b Streptococcus, would this infant qualify for late sepsis?

A: No, this baby would not be included as septic because there are too many other possibilities, but this baby would still qualify as a Small Baby.

Item 44a. Necrotizing Entercolitis

Item 44b. Nec Surgery

Item 45. Focal GI Perforation

Q: How would I code an infant with free air in the abdomen when we don't know whether it was from NEC or from isolate ileal perforation? Should I answer NEC as "No" or "Unknown"?

A: If the infant has free air in the abdomen, but does not satisfy the criteria in the definition of NEC, then the answer to NEC is "no".

Q: For the same situation as above, how should I answer for Focal GI perforation?

A: If the infant with free air did not have a focal GI Perforation identified at surgery or postmortem, the answer to Focal GI Perforation is "No".

Q: Should I code an infant who receives a peritoneal drain as NEC surgery even though it may not survive for definitive surgery to figure out why the perforation?

A: If the infant had peritoneal then the answer to NEC Surgery is "No". Instead you must answer "Yes" to Item 47a. Other surgery and use surgery code S333.