sepsis with respitory failure

I have an ER that has the final dx as fever, dehydration, gastroenteritis and sepsis with respiratory failure. I am not sure how to code the sepsis with resp failure. I am still quite new at coding and would appreciate a little help.
Thank You

re: sepsis with respitory failure

I would code it as 038.9 (infection), 995.91 or 995.92 if severe sepsis was mentioned in the chart (systemic disease), 518.81 (local infection)

Coding scenario I read from www.ahima.org

An 89-year-old female was taken to the emergency department after being found semi-conscious with markedly abnormal vital signs—a fever of over 101 degrees Fahrenheit, a heart rate of 100 beats per minute, and a respiratory rate of 22 breaths per minute. On admission to the intensive care unit, the physician documented her condition as severe sepsis with acute respiratory failure. The final diagnosis, provided by the physician, was gram-negative sepsis with acute respiratory failure.

In ICD-9-CM, the following codes would be assigned:
038.40, Septicemia due to gram-negative organism, unspecified
995.92, Severe sepsis
518.81, Acute respiratory failure

If sepsis or severe sepsis is present on admission, and meets the definition of principal diagnosis, the systemic infection code (038.xx, 112.5, etc.) should be assigned as the principal diagnosis, followed by code 995.91, Sepsis, or 995.92, Severe sepsis, as required by the sequencing rules in the Tabular List. Codes from subcategory 995.9 can never be assigned as principal diagnosis. A code should also be assigned for any localized infection, if present. Hope this help.

re: sepsis with respitory failure

Sepsis with respiratory failure, the sepsis (ex, 038.9) is sequenced first because there is an instructional note under subcategory 995.92 indicating to code first the underlying systemic infection. In addition, code 995.92 has a "use additional code" note to specify organ dysfunction and lists acute respiratory failure (518.81). As a result, respiratory failure would be sequenced as a secondary diagnosis.

re: sepsis with respitory failure

Thank you both for the help!!!!