Which definition of the deadly condition will be applied in the Empire State has been a hot topic of late. EDITOR’S NOTE: The following is partial transcript of remarks made by Dennis Jones during a recent RACmonitor-produced Monitor Mondays broadcast. First, let me remind everyone that I am in the…
Higher overturn rates noted when the appeal is filed outside of the payer’s internal appeal process.  I’d like to share some information gained from appealing over 2,000 clinical validation denials for sepsis in the state of New York since the time of the release of the Sepsis-3 criteria in February…
Lack of a SOFA score change does not rule out sepsis. A couple weeks ago, I spoke about how the current definition of sepsis, known as "sepsis-3," was the best definition for the medical community to use at this time. This week, I'm going to discuss the clinical diagnosis of…
The biggest holdout to Sepsis-3 is still CMS. UnitedHealthcare has announced that it will be adopting the Third International Consensus Definition for sepsis and septic shock for all of its lines of business, effective Jan. 1, 2019. This definition is better known as "Sepsis-3." The announcement is significant because it…
I want to begin with a coding scenario: sepsis and pneumonia are documented, and the coder captures these conditions and assigns MS-DRG 871 and APR-DRG 720 with severity of illness (SOI) 2.  Sepsis presents challenges for coders as well as clinicians. I want to provide insight into the complex molecular…
The Centers for Medicare & Medicaid Services (CMS) and third-party auditors are going after sepsis admissions for which patients are discharged within 72 hours. It may seem preposterous, from the hospital’s perspective, that they are being allegedly unfairly targeted for payment denials for sepsis admissions. But is this actually the…
Consider the following scenario: A 25-year-old female presents to the ED with RLQ pain, onset three days ago. She reports that the pain is aggravated by palpation. She had just returned from a visit out of the country when she developed nausea with vomiting and fever. On admission, the patient…