A New Code: Z51.A, Encounter for Sepsis Aftercare

By Erica Remer, MD, FACEP, CCDS, ACPA-C

Today I am going to focus on a new ICD-10-CM code, as of Oct. 1: Z51.A, Encounter for sepsis aftercare.

We think about sepsis mortality a lot. Since there isn’t a universally applied definition of sepsis, exact rates are elusive. According to the Centers for Disease Control and Prevention (CDC), 75 percent of sepsis deaths in the United States are in the Medicare population, and the death rate for this group exceeds 300 deaths per 100,000 people.

The death rate is higher for men, as opposed to women, Blacks compared to others, and rural versus urban dwellers, and mortality also is noted to increase with age.

Dying is not the only consequence of sepsis. Besides the fact that sepsis survivors are at higher risk for another bout of sepsis from a subsequent infection (and for readmission), there are potential sequelae of sepsis, especially if a patient was in an intensive care unit. The condition “post-sepsis syndrome” (PSS), which includes long-term physical, cognitive, and psychological effects after surviving sepsis, affects up to half of all sepsis survivors.

A nice graphic detailing the manifestations of PSS can be found in this article:  Understanding Post-Sepsis Syndrome: How Can Clinicians Help? Physical manifestations of PSS can include dyspnea, heart failure, chronic kidney disease, immunosuppression, fatigue, and muscle and joint pain. Mental effects include post-traumatic stress disorder, depression, deranged sleep, and memory deficits.

There are striking similarities and overlaps between PSS, post-intensive care syndrome (PICS) and post-acute sequelae of SARS-CoV-2 (PASC). Most patients who develop PSS and PICS had been gravely ill; long COVID can persist even after a seemingly minor bout of COVID-19. That condition is the only disorder that has a dedicated ICD-10-CM code, U09.9, Post-COVID-19 condition, unspecified, and the specific condition (e.g., loss of smell or pulmonary embolism) is meant to be coded first.

There is no way to code PSS in ICD-10-CM at the present time.

Once resolved, there is no way to capture that a patient had suffered and survived sepsis. After resolution, a code indicating sepsis (e.g., A41.9, Sepsis, unspecified organism) is no longer appropriate, because that is for an acute and current episode of sepsis. Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, is non-specific, requires an additional code to identify any applicable history of disease code, and would not be considered appropriate if there were persistent issues related to the condition, because treatment would not be “completed.” Z86.19, Personal history of other infectious and parasitic disease, is again non-specific and is not appropriate if there are ongoing medical issues.

As a result, University of Colorado/UCHealth submitted a request to the CDC for a code to indicate sepsis survivorship (Topic Packet March 2023), and it was discussed in the Coordination and Maintenance Committee Meeting in March 2023. In particular, UCHealth felt that post-acute care and home health care could benefit from having a means to signify continued recovery from sepsis. They felt that increased awareness among healthcare providers and policymakers would be beneficial, and that it would be easier to perform epidemiological monitoring post-sepsis.

Z51 is Encounters for other aftercare and medical care, and we are instructed to also code the condition requiring care. Since the condition is still ongoing, there is an Excludes1 for using the follow-up exam after treatment code, Z09. I would envision that a primary care provider following up after a hospitalization for sepsis, home health continuing care, physical or occupational therapy, and post-acute facilities will welcome the ability to assign Z51.A, Encounter for sepsis aftercare, to explain why they are treating ongoing sequela. It is not entirely clear to me for how long this code would be utilized. If there are ongoing manifestations, obviously. But the increased of risk of recurrent sepsis is for at least a year, even if there are no long-lasting obvious sequelae.

I wish they had developed a specific code for personal history of sepsis, too. I think there will be times when there is no longer sepsis aftercare being provided, but it would be useful to know that a patient had the condition in the past and might be vulnerable to another episode now. Z86.19 is too vague for me.

There’s a big difference between having had the chicken pox or strep throat and sepsis.

Until this is all sorted out, I am still grateful for this new code. I think it will contribute to our overall understanding of sepsis.