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. Independence 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.

Independence 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.