Q&A: Preventing sepsis denials

Q: If a provider documents sepsis with acute kidney injury (AKI) but does not explicitly link the two conditions, should they be queried to prevent the claim from being denied?

A: If a provider documents sepsis without linking it to the organ dysfunction, coders should query for clarification. [In this case, the coder] should query whether the AKI is related to sepsis or another condition within the current state.

Work closely with providers to educate them on documentation best practices that align with payer expectations.

Coding queries [can help] capture essential details such as organ dysfunction or infection sources. Queries help fill in gaps in documentation, ensuring that clinical indicators support the sepsis diagnosis. Many sepsis denials result from missing SOFA scores, infection sources, or lack of clinical linkage.

Editor’s note: This question was answered by Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCDS, CDIP, during the HCPro webinar “Sepsis Documentation and Coding Preventing Denials With Precision.”