September was designated as Sepsis Awareness Month in 2011 by the Sepsis Alliance. Three years later, the CDC recognized the month of awareness, stating: “Despite the fact that sepsis affects more than a million Americans each year and kills up to half of them, a new survey published by Sepsis Alliance found that fewer than half of all Americans have ever even heard of the term ‘sepsis.’”
Sepsis is a serious illness where the body’s natural response to infection malfunctions and can become life-threatening. The illness occurs following an infection, causing a chain reaction throughout the body, which can lead to tissue damage, organ failure, and death without timely treatment.
Without appropriate treatment of sepsis within the first few hours, the spiral of death would be practically irreversible.
The lack of awareness shared by the CDC is even more startling when we consider sepsis’ effect on Americans:
- Each year, at least 1.7 million adults in America develop sepsis.
- Nearly 270,000 Americans die as a result of sepsis.
- 1 in 3 patients who die in a hospital has sepsis.
The overwhelming prevalence of sepsis is why Accuity is committed to helping our hospitals and their communities in raising sepsis education and awareness. The first step is to look at the difficulties hospitals face in the fight against sepsis. The challenge with sepsis in a clinical sense is that it is hard to define, which leads to difficulty diagnosing it. In 2016 there was a task force set up to create a new definition for sepsis.
The definition they settled on was: “life-threatening organ dysfunction due to a dysregulated host response to infection.” In contrast, septic shock is defined as “a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities substantially increase mortality.” Thus, septic shock represents a more severe illness with a much higher likelihood of death than sepsis alone.”
But this creates a two-fold problem. The first is that while some physicians will adopt the new definition, others will continue to diagnose based on the previous. Inaccurate or outdated definitions lead to the next problem, which is the coding issues that arise when sepsis is not diagnosed until the patient is critically ill because of the inconsistency in which the definition is applied.
These two problems then lead to inconsistencies in billing. To address this issue, clinicians must look at each case holistically, ensuring the clinical documentation relates to the final bill after DRG reconciliation.
Health Information Associates explains: “This can lead to case denials unless the physician documentation fully describes the severity of the patient’s condition and supports the clinical diagnosis of sepsis. Coders will have to take this into consideration when trying to decide if a query is appropriate. If the documentation is not adequate, a query would not be recommended.”
With the help of an experienced partner like Accuity, the coding and clinical documentation plan for sepsis can be standardized within an organization to alleviate the issues facing hospitals. This way, with all healthcare professionals on the same page, the focus of sepsis can be early diagnosis and treatment.