Denial re sepsis without bacteremia


I was wondering if anyone had encountered any similar denials and how you approached it:

Pt was admitted w/ sepsis as noted by the attending provider in multiple notes including the discharge summary.  The clinical indicators for sepsis were not a slam dunk so to speak but were present nonetheless.  An ID consult was done where the doctor stated there was no bacteremia.  ID did not document sepsis but never stated there was no sepsis.  The denial states this is conflicting documentation and a query should have been sent for further clarification.  The auditor is also using the guidelines that state that "Negative or inconclusive blood cultures do not preclude a diagnosis of sepsis in patient with clinical evidence of the condition; however the provider should be queried."  Obviously a query was not sent and the sepsis was coded as the pdx.

Anyone seen/experienced anything similar or could offer some thoughts?


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