Sepsis "Syndrome"
We had a denial today that I coded as Sepsis as primary diagnosis when the wording of the diagnosis was "Sepsis Syndrome". The insurance company cited Coding clinic Second quarter 2012 page 21-22 that states "sepsis syndrome" is poorly defined and should be queried. They denied it and assigned a lesser DRG. I guess I didn't realize that coding clinic existed and in light of it, have to agree with the insurance company. My question is, how exactly would you query for clarification of Sepsis Syndrome? Interestingly enough, a chart I reviewed today has the same diagnosis.
Thanks!
Peggy
Thanks!
Peggy
Comments
this is auditors utilizing coding clinic to their full advantage, in my opinion ;-). sepsis 'syndrome' has clinically typically been thought of as sepsis with organ dysfunction (ie: severe sepsis). However, the coding clinic is there, so yes it needs to be clarified.
we would query the same way as you would for 'urosepsis', basically stating that this is nonspecific terminology from a coding perspective and to please clarify if by 'sepsis syndrome' they mean sepsis, severe sepsis, other, unable to determine.
Katy Good