Billing for Sepsis

Billing and Reimbursement
Policy Number: MRP-P-001

Last Updated: Sept. 28, 2022

Based on the recommendation from 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. Patients are likely to have a prolonged hospital or ICU stay. As such, inpatient admissions with a diagnosis of sepsis but a stay of three consecutive nights or less will be denied for improper diagnosis. It is likely these cases are instead a rule out sepsis and more likely dehydration, urinary tract infection or other diagnosis that should be more accurately submitted. 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 of three nights or less.   

This policy went into effect Sept. 1, 2021.