Billing for Sepsis

Based on the recommendation from The Journal of the American Medical Association (JAMA), The Third International Consensus Definitions for Sepsis and Septic Shock Sepsis-3, sepsis should be defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.

Claims with Sepsis diagnosis will be subject to a review performed on a case-by-case basis.

We will accept a sepsis diagnosis with an appropriate discharge status code for patients who expire or are transferred to other facilities or hospice with a diagnosis of sepsis resulting in an inpatient stay. 

This policy went into effect Oct. 1, 2025.