Skip to main content

Severe Sepsis and Septic Shock 2023 CMS Guidance

Severe Sepsis and Septic Shock: Management Bundle (Composite Measure) Severe Sepsis Present Data Element Version 5.14a Questions and Answers

Effective for July 1, 2023, through December 31, 2023

"Participants will be able to understand and interpret the guidance in Version 5.14a, effective for July 1, 2023, through December31, 2023 discharges, of the specifications manual, specific to the Severe Sepsis Present data element, to ensure successful reporting for the SEP-1 measure for the Hospital Inpatient Quality Reporting Program."

A few highlights from the document include:

To establish the presence of severe sepsis by clinical criteria, all three clinical criteria (a, b, and c) must be met within six hours of each other. The three clinical criteria do not need to be documented in any particular order. 

a. Documentation of an infection 

b. Two or more manifestations of systemic infection according to the Systemic Inflammatory Response Syndrome (SIRS) criteria 

c. Organ dysfunction

(Slide 10)


For evidence of acute respiratory failure:  Use the time when mechanical ventilation was started or the time when the mechanical ventilation changed from intermittent to continuous. (Slide 21)


link to document: Severe Sepsis and Septic Shock

https://www.qualityreportingcenter.com/globalassets/iqr-2023-events/iqr12523sep/december2023_sep_1_npc_vfinal508wp.pdf



Popular posts from this blog

Table VI-4. Disease Hierarchies for the 2017 CMS-HCC Model

If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column is found here : Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Found at: https://www.cms.gov/Medicare/HealthPlans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf P 87 If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the dat...

MEDICARE PREVENTIVE SERVICES FROM MEDICARE LEARNING NETWORK

This is a link to further information on the Medicare Preventive Services. The layout of it reminds me of a bingo card!  Medicare Learning Network is the educational arm of Centers for Medicare and Medicaid Service (CMS). Remember this is further information on different types of screenings available to Medicare beneficiaries. https://www.cms.gov/Medicare/ Prevention/PrevntionGenInfo/ medicare-preventive-services/ MPS-QuickReferenceChart-1. html#AWV Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

Guidelines for HIV coding

Chapter 1: Certain Infectious and Parasitic diseases (A00-B99) Human Immunodeficiency virus (HIV) Infections B20 Human immunodeficiency virus (HIV) disease (symptomatic) R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV) Z20.6 Contact with and exposure to human immunodeficiency virus (HIV) Z11.4 Encounter for screening for human immunodeficiency virus (HIV) Z71.7 human immunodeficiency virus [HIV] counseling Z21 Asymptomatic human immunodeficiency virus (HIV) infection status “Confirmation” does NOT require documentation for positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIV-related illness is sufficient.   Once a patient is diagnosed with B20, they should never be assigned R75 or Z21. Sequencing of HIV Codes B20 should be sequenced as the first-listed diagnosis when patient is treated for an HIV related condition. Any non-related conditions get sequenced followi...