Original Policy Date
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Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
To ensure the appropriate ICD-9CM codes are being used for inpatient hospitalizations for the clinical diagnosis of Septicemia. It is noted that the average mean length of stay for MS DRG 872 which is Septicemia or Severe Sepsis without mechanical ventilation and without major complication, is 5.2 days.
Systemic Response: Systemic Inflammatory Response Syndrome (SIRS ) → Sepsis → Sepsis Syndrome → Septic Shock → Multi-organ Dysfunction Syndrome
- Temperature > 100.4F (38C) or Temp < 97 (36C)
- HR > 100
- Hypotension (SBP< 100)
- WBC > 12K or < 4K and/or > 10% bands
- RR > 24/min; and/or pCO2 (arterial) < 32mmHg
- Monitoring of vital signs every 4 hours; in particular blood pressure, temperature, pulse, respiratory rate and heart rate
- Evaluation of mental status changes
- Laboratory evaluation: blood and urine cultures, CBC with differential, chemistry
Treatment of underlying infection with appropriate antibiotic, anti-fungal, and/or anti-viral.
IV Fluids and/or medications which are being given to maintain hemodynamic stability.
Supplemental oxygen is being given to maintain oxygenation.
To ensure accurate facility coding of Septicemia based upon Blue Cross of Idaho clinical guidelines.
Previously, facility billing for Sepsis, Septicemia, SIRS, Severe Sepsis or Septic Shock was reviewed through post payment audit. As of July 1, 2012, hospital charges for the above diagnosis may be reviewed on a prepayment basis for accurate coding and documentation in the medical record.
|04/03/12||Add to Administration section||New policy|