Blue Cross Blue Shield of North Dakota (BCBSND) continually develops coding and billing guideline resources in response to rapidly changing medical technology and updates to the coding sets. We are seeing an increase of appeals related to sepsis short stays and so we have developed a guideline.
This guideline will provide billing and coding guidance for Sepsis Outpatient and Inpatient Short Stays to ensure the patient’s status is appropriately billed based on the patient’s diagnoses and treatment performed.
Please review the new guideline:
- Claims with a sepsis diagnosis and status of Outpatient Short Stay will be denied when the stay is 0-1 days with the following parameters.
- Discharge status of:
- Discharge to home or self-care (01)
- Discharged/transferred to home under care of organized home health service organization in anticipation of covered skills care (06)
- Left against medical advice or discontinued care (07)
- Sepsis Diagnosis-related groups (DRGs):
- 870 — Septicemia or Severe Sepsis with Mechanical Ventilation (MV) > 96 Hours or Peripheral Extracorporeal Membrane Oxygenation
- 871 — Septicemia or Severe Sepsis without Mechanical Ventilation (MV) > 96 hours with Major Complication/Comorbid Condition (MCC)
- 872 — Septicemia or Severe Sepsis without Mechanical Ventilation (MV) > 96 hours without Major Complication/Comorbid Condition (MCC)
Questions?
For additional questions contact the appropriate Provider Service Center:
- Commercial: 800-368-2312
- Medicaid Expansion: 833-777-577
