MS-DRG 871: Septicemia or Severe Sepsis without MV >96 Hours with MCC
Sepsis + MCC. HIGHEST VOLUME MEDICAL DRG IN US
Typical indications
- Pneumonia + sepsis
- UTI + sepsis
- GI source + sepsis
Common denial patterns
- Sepsis criteria meeting (Sepsis-3 vs SIRS)
- MCC clinical validation
- Quality issues — SEP-1 bundle compliance
Appeal angles
Document Sepsis-3 criteria (qSOFA ≥2 or SOFA ≥2), lactate, blood cultures, antibiotics timing, SEP-1 bundle compliance.
Context: how MS-DRGs work
MS-DRGs bundle hospital inpatient payment into a single amount per admission. Each DRG has a relative weight that multiplies the hospital's base rate to determine payment. 871 has relative weight 1.8745. Major Complication or Comorbidity (MCC) and Complication or Comorbidity (CC) secondary diagnoses can move a case to a higher-paying DRG within the same family.
Frequently asked questions
What is MS-DRG 871?
Septicemia or Severe Sepsis without MV >96 Hours with MCC. Sepsis + MCC. HIGHEST VOLUME MEDICAL DRG IN US.
What are typical indications?
Pneumonia + sepsis; UTI + sepsis; GI source + sepsis.
Why are claims under this DRG denied?
Sepsis criteria meeting (Sepsis-3 vs SIRS); MCC clinical validation; Quality issues — SEP-1 bundle compliance.
How do I appeal?
Document Sepsis-3 criteria (qSOFA ≥2 or SOFA ≥2), lactate, blood cultures, antibiotics timing, SEP-1 bundle compliance.
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