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Updated: Jul 17, 2025

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression

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Published on: June 15, 2019

Sepsis-2.5: Resolving Conflicts Between Payers and Providers.

Howard Rodenberg¹, Theodore Glasser¹, Alison Bartfield¹

¹Departments of Clinical Documentation Integrity and Internal Medicine, Baptist Health, Jacksonville, FL.

Critical Care Explorations

|August 30, 2023

Summary

This summary is machine-generated.

Conflicting sepsis definitions impact medical coding and payments. The new Sepsis-2.5 definition, developed collaboratively, resolves provider-payer disputes by unifying clinical illness, infection source, and organ dysfunction criteria for sepsis diagnosis and reimbursement.

Keywords:

clinical coding diagnosis-related groups documentation financial management hospitals sepsis

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Published on: December 18, 2010

Area of Science:

Medical Science
Healthcare Administration
Clinical Informatics

Background:

Competing definitions of sepsis create significant clinical, coding, and payment challenges.
Clinician preference for Sepsis-2 contrasts with payer utilization of Sepsis-3, leading to payment denials and recoupment requests.

Purpose of the Study:

To develop a consensus definition for sepsis that addresses conflicts between healthcare providers and payers.
To establish a literature-supported, community-based definition facilitating accurate sepsis diagnosis and reimbursement.

Main Methods:

A cooperative project between a hospital system and a private payer.
Development of a new sepsis definition, termed 'Sepsis-2.5', based on literature review and consensus.

Main Results:

The Sepsis-2.5 definition integrates clinical illness, a source of infection, and evidence of organ dysfunction.
Implementation of Sepsis-2.5 has been instrumental in resolving provider-payer conflicts regarding sepsis definition and reimbursement.

Conclusions:

The Sepsis-2.5 definition provides a unified approach to diagnosing sepsis, aligning clinical practice with reimbursement requirements.
This consensus definition effectively bridges the gap between provider and payer perspectives on sepsis, improving healthcare financial processes.