Sepsis for CMS

On Oct 1, 2015 CMS began requiring hospitals to report their data on how they meet certain metrics for patients with “severe sepsis” via Sepsis Bundle Project v 5.0a. As with everything CMS, the details are things we need to know.

The reality is that these definitions are here, so rather than debate whether the metrics and definitions make sense (particularly in light of newer sepsis data), this post provides the definitions OUR coders are currently looking for to see if a patient should be included in the reporting data, so we can adjust our practice accordingly.

1. SIRS (Systemic Inflammatory Response Syndrome)

ANY 2 of the below:

  • Temp >38.3, <36.0
  • HR >90
  • RR >20
  • WBC >12.0, <4.0, OR 10% Bands
  • Altered Mental Status

2. SEPSIS = SIRS + “a possible source of infection”

3. Severe Sepsis: SIRS plus evidence of organ failure. 

  • This is an area where I think the definition may be escaping us, because lots of these things are things that are less immediately clinically relevant, but make semi-sick folks meet the definition of severe sepsis.
  • These are the patients who NEED to get the “Three Hour Bundle”
  • SBP <90 or MAP <65 ONE TIME (yes the spurious accidentally entered values entered by the nurse count)
  • Lactate >2.0
  • Creatinine>2.0 (excluding ESRD patients)***
  • Platelets <100K
  • Bilirubin >2.0
  • INR > 1.5
*** If your patient chronically has a creatinine of 1.9, and comes in at 2.1, YES, they will qualify for severe sepsis, UNLESS you document in your note that this is essentially unchanged from prior values.  Remember our coders can’t make decision on what is “clinically significant” – you have to tell them whether it is.

4. The “3-Hour Bundle”

The three Hour bundle are things that need to be completed within 3 hours from the TIME SIRS is recognized (Usually the time of first vital signs).

a.  BOLUS of 30 cc/kg if SBP <90 OR Lactate >4.0 (regardless of history of renal failure, CHF, etc…) Remember, you think these folks are septic, not fluid overloaded, etc as a cause of their vital sign abnormalites.

b. Lactate must be drawn BEFORE bolus

c. Cultures of blood and urine before antibiotics

d. Appropriate antibiotics for the “suspected infection source” must be initiated

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