Sepsis3

BrandeiskyJohn

We have a denial from a payor who is using Sepsis 3 as their definition.  We went back into the chart and found based on the SOFA score in the definition we had a "3 pointer " because the bilirubin was 6.0
This was due to cholecystitis / source of infection.  Based on sepsis 3, we are thinking that we meet the criteria. Our question is, are we right ?  Thanks and enjoy the long weekend everyone.

vparent@emhs.org

SOFA 3 scoring is really establishing the risk of mortality on certain patients but from the article below if your patient described above had no organ dysfunction prior to this a SOFA score of 6 indicates a high percentage of dying BUT if this patient already had end stage renal and liver failure, a score of 6 is not so significant. We essentially still use Sepsis 2 criteria to identify sepsis but are aware of the need for organ failure to be involved for it to meet sepsis 3 criteria. When we have a payor site their use of SOFA 3, we reply back that it is a scale for severity of sepsis and provide them with our own policy and protocol for identifying and treating sepsis.

"the task force recommends using a change in baseline of the total SOFA score of 2 points or more to represent organ dysfunction (Box 3). The baseline SOFA score should be assumed to be zero unless the patient is known to have preexisting (acute or chronic) organ dysfunction before the onset of infection. Patients with a SOFA score of 2 or more had an overall mortality risk of approximately 10% in a general hospital population with presumed infection.1

https://jamanetwork.com/journals/jama/fullarticle/2492881

hrboissonneault

vparent@emhs.org have you found that "When we have a payor site their use of SOFA 3, we reply back that it is a scale for severity of sepsis and provide them with our own policy and protocol for identifying and treating sepsis." is beneficial in having denials overturned?