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The facility has received a clinical validation denial for sepsis.

The facility has received a clinical validation denial for sepsis. The denial states sepsis is not a clinically valid diagnosis because it does not meet Sepsis-3 criteria. The facility has a policy stating it uses Sepsis-2 criteria. What is the BEST next step?

A.

Remove sepsis from all claims where the diagnosis is not supported by sepsis 3 criteria.

B.

Appeal the denial because all payors must use the hospital's sepsis criteria when reviewing their claims.

C.

Query physicians when Sepsis-3 criteria is not met so they can provide additional documentation to support the diagnosis.

D.

Have the contracting department work with payors to obtain agreement on how sepsis will be clinically validated.

AHIMA CDIP Summary

  • Vendor: AHIMA
  • Product: CDIP
  • Update on: Jul 20, 2025
  • Questions: 140
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