Different Sepsis criteria used by different payers

DeannaLaDueDeannaLaDue
in Denials

Hi everyone, I am a CDI Supervisor and we are having some denials due to which sepsis criteria the insurance companies are using. Since some use sepsis 2 and some use sepsis 3 criteria, the question of how to deal with it from a CDI/Coding standpoint has come up.

I'd love to hear how others have been navigating this.

Thanks!

Deanna LaDue RN CCDS

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Comments

  • cgoeweycgoewey

    Our institution is not changing its sepsis criteria based on what payors use. We have decided if a payor has a policy stating they use Sep-3 and the pt doesn't meet Sep-3 we do not appeal as we have found it is a waste of our time as the payor will uphold their denial if they have a policy stating they use Sep-3.

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