Septicemia Is Increasing 11. Fear Factor 12. However, the OIG's premise in the report for differentiating the two DRG codes conflicts with the authoritative coding guidance on the subject. A clinical analysis of septicemia exposes the OIG's false claim of possible widespread upcoding to DRG 416. Septicemia, commonly known as an infection involving the bloodstream, is a very serious syndrome that recently replaced homicide as the 12 th leading cause of death of the overall population in the United States.
Septicemia can result from bacteria infecting the bloodstream in various ways.
Septicemia in the Medicare population often occurs as a result of a urinary tract infection that has extended into the bloodstream. In some instances, these patients are treated initially with antibiotics on an outpatient basis. Occasionally, the empirically chosen antibiotics will not cover the specific infection in the urinary tract and inpatient admission can result from such treatment failures. When antibiotics are ineffective and time has elapsed, the infection may spread into the systemic circulation. Blood cultures can be affected by prior outpatient antibiotic treatment and are not reliable in confirming or excluding the diagnosis of septicemia.