Sepsis is a life-threatening reaction to infection. When documenting,
coding, and/or billing a diagnosis of sepsis, the correct criteria should be
applied to ensure consistency and compliance with the Sepsis-3 definition.
AmeriHealth uses The Third International Consensus Definitions for Sepsis
and Septic Shock (Sepsis-3), which was published as a special communication
in the Journal of the American Medical Association (JAMA), February 23,
2016.
What is sepsis?
- Sepsis is defined as a life-threatening organ dysfunction by a dysregulated
host response to infection. (As a result, emergent treatment is required to
maintain hemodynamic stability while treating the underlying cause of the
sepsis.)
- In lay terms, sepsis is a life-threatening condition that arises when the
body’s response to an infection injures its own tissues and organs.
- Sepsis involves organ dysfunction, indicating a pathobiology more complex
than infection plus an accompanying inflammatory response alone.
- Sepsis warrants greater levels of monitoring and intervention, including
possible admission to critical care units.
AmeriHealth will continue to review medical records and clinical information
to ensure sepsis is assigned per Sepsis-3 criteria. Claims submitted not
meeting clinical support for Sepsis-3 may be subject to adjustment in
reimbursement.
Learn more
For more information, please visit the JAMA Sepsis website.