Coding Elevated: White Paper 2017The Society of Critical Care Medicine (SCCM) met in 2016 to update the definition of sepsis. During this Summit, it was determined that the presence of Systemic Inflammatory Response Syndrome (SIRS) markers in response to an infectious source may just be a normal physiologic response and not a sufficient indicator of sepsis. Instead, SCCM determined sepsis should be what clinicians, coders and others in the medical community have historically termed “severe sepsis,” meaning the infection is critical enough to result in organ dysfunction. This 2016 SCCM decision launched a conundrum of coding, clinical documentation and denial issues.
- Denials for sepsis cases increased as auditors use the updated SCCM criteria while providers continue with established coding guidelines for sepsis.
- SCCM physicians updated sepsis criteria in 2016, but other stake holders such as CDI specialists and clinical coders were not part of the conversation.
- The consequences from recognizing multiple sepsis criteria sets has adverse effects on documentation, coding, billing and reimbursement.
Read more in our white paper below.