Sepsis 2

edited February 2023 in Denials

We have recieved denials stating that 2 or more of the following criteria is not enough unless we see 2 to 3 of these readings consecutively. I do not see this requirement written (stated)anywhere except in denials.

What I see is if you have 2 or more of these signs consider sepsis. (RR, Temp, WBC, HR) , but the denials are saying we need to take that a step further and need 2-3 readings of those 2 or more.

I also have read that with initial treatment for sepsis those vitals can change quickly, so in this case how would we have multiple vital readings?

I have to believe this is just another tactic for payers to deny by twisting meanings.

This question is specific to the vitals as I do realize we need much more once have infection and 2 or more.

Thank you,



  • Actually, I tend to agree with the philosophical point.

    An isolated reading without context could simply be an aberration. A patient whom is that sick is likely to be getting vitals checked by nursing (especially in these days of electronic monitoring) every 15 minutes.

    I would expect to see more than one reading for vital signs. Other items (like WBC or lactic acid), not so much; the collection interval for those is much longer.

    Related, be cautious of sepsis indicators that can be easily attributed to another cause (RVR afib; WBC but on steroids for COPD flare; similar). I would argue that one should exclude those as acceptable indicators.


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