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New Proposal Could Hurt Sepsis Patients

November 11, 2019
A new CDC proposal to change ICD-10-CM sepsis related codes could have the unintended consequence of discouraging early sepsis identification and treatment

A few days ago, Sepsis Alliance learned the Centers for Disease Control and Prevention (CDC) issued a proposal to accept Sepsis – 3 diagnostic criteria for ICD-10 coding. ICD-10-CM is a coding system used by healthcare professionals to classify a patient’s diagnosis, as well as symptoms, and procedures performed in a doctor’s office or healthcare facility. The issue with the Sepsis – 3 diagnostic criteria is that these are mortality predictors rather than diagnostic. Mortality predictors suggest who will not survive a particular illness. In the case of sepsis, the Sepsis – 3 diagnostic criteria do not take into account the early stages of sepsis, meaning many sepsis cases could be missed or go untreated until the patient is critically ill. This change could negatively affect providers, hospitals, and patients by:

  • Empowering third-party payors to deny payment for early life-saving sepsis treatment
  • Disincentivizing healthcare providers and hospitals from diagnosing and treating sepsis early, because they would no longer be paid for doing so
  • Saddling patients and families with the cost of necessary sepsis treatment that third-party payors refuse to pay

Sepsis Alliance partnered with The Rory Staunton Foundation on a comment letter in opposition to this proposal.

To read our joint comment letter click here.