{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:46:40Z","timestamp":1782312400507,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01\u2010HL160588"],"award-info":[{"award-number":["R01\u2010HL160588"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the prevalence and financial impact of Sepsis\u20103 concordant vs. Sepsis\u20103 discordant sepsis hospitalizations in Traditional Medicare inpatient claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Setting<\/jats:title>\n                    <jats:p>This retrospective observational study used a 100% sample of Traditional Medicare inpatient claims from 2016 to 2022. The study population included acute care hospitals reimbursed under the Inpatient Prospective Payment System, excluding those in Maryland and U.S. territories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>All Medicare beneficiaries with hospitalizations for sepsis, identified by DRGs 870\u2013872, who were continuously enrolled in Medicare Parts A and B. Hospitalizations were classified as Sepsis\u20103 concordant vs. discordant based on the presence of diagnosis codes for acute organ dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Among 4.2 million hospitalizations with a sepsis DRG from 2016\u20132022, 22.6% (95% CI: 22.3%, 22.9%) lacked a diagnosis code for acute organ dysfunction and were classified as Sepsis\u20103 discordant. These hospitalizations were most commonly associated with alternative diagnoses of pneumonia (27.4% (95% CI: 27.2%, 27.7%)), urinary tract infection (27.4% (95% CI: 27.2%, 27.6%)), and skin or subcutaneous tissue infections (9.7% (95% CI: 9.5%, 9.8%)). Thirty\u2010day mortality was substantially lower among Sepsis\u20103 discordant (7.7% (95% CI: 7.6%, 7.8%)) versus concordant (33.4% (95% CI: 33.1%, 33.6%)) sepsis hospitalizations, suggesting meaningful clinical differences among patients with Sepsis\u20103 discordant sepsis diagnoses. Hospital payments for Sepsis\u20103 discordant sepsis hospitalizations averaged $839 (95% CI: $679, $999) more per hospitalization than alternative simple infections, leading to an estimated $114 (95% CI: $92, $136) million higher annual payments to hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly one in four inpatient sepsis hospitalizations in Traditional Medicare may be discordant with Sepsis\u20103, leading to substantial increases in spending. CMS could mitigate this by aligning ICD\u201010 coding guidelines with clinical definitions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70135","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:50:54Z","timestamp":1782294654000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Sepsis Coding and Payment to\n                    <scp>U.S.<\/scp>\n                    Hospitals"],"prefix":"10.1111","volume":"61","author":[{"given":"Andrew M.","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hallie C.","family":"Prescott","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2754-0979","authenticated-orcid":false,"given":"Yan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayden","family":"Rooke\u2010Ley","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1045-6610","authenticated-orcid":false,"given":"Jason D.","family":"Buxbaum","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"The Centers for Disease Control & Prevention (CDC) \u201cCaring for Patients With Sepsis. Sepsis \u201dpublished March 8 2024 accessed February 7 2025 https:\/\/www.cdc.gov\/sepsis\/hcp\/clinical\u2010care\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/sepsis\/clinicaltools\/index.html."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19809"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003342"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2019638"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1553"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(14)70246\u20102"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004224"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201809\u2010646PS"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010016\u20101266\u20109"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000050454.01978.3B"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0288"},{"key":"e_1_2_9_15_1","unstructured":"Centers for Disease Control and Prevention & Centers for Medicare & Medicaid Services \u201cICD\u201010\u2010CM Official Guidelines for Coding and Reporting. CDC \u201dpublished June 7 2024 https:\/\/www.cdc.gov\/nchs\/icd\/icd\u201010\u2010cm\/index.html."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000001004"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010015\u20101035\u20101"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201910\u2010757RL"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad101"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003324"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.384"},{"issue":"3","key":"e_1_2_9_22_1","first-page":"1g","article-title":"Current Challenges in Sepsis Documentation and Coding: A Review of the Literature","volume":"20","author":"Sand J.","year":"2023","journal-title":"Perspectives in Health Information Management"},{"key":"e_1_2_9_23_1","unstructured":"Centers for Medicare & Medicaid Services \u201cImproper Payment Rates and Additional Data \u201dpublished January 16 2026 https:\/\/www.cms.gov\/data\u2010research\/monitoring\u2010programs\/improper\u2010payment\u2010measurement\u2010programs\/comprehensive\u2010error\u2010rate\u2010testing\u2010cert\/improper\u2010payment\u2010rates\u2010and\u2010additional\u2010data."},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.12"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu750"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.13836"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.00596"},{"key":"e_1_2_9_28_1","unstructured":"Association of Clinical Documentation Integrity Specialists \u201cUnitedHealthcare Adopts Sepsis\u20103 Criteria for Claims Validation \u201dpublished October 11 2018 accessed February 9 2026 https:\/\/acdis.org\/articles\/news\u2010unitedhealthcare\u2010adopts\u2010sepsis\u20103\u2010criteria\u2010claims\u2010validation."},{"key":"e_1_2_9_29_1","unstructured":"Association of Clinical Documentation Integrity Specialists \u201cCigna Adopts Sepsis\u20103 Criteria for Claims Validation \u201dpublished March 5 2020 accessed February 9 2026 https:\/\/acdis.org\/articles\/news\u2010cigna\u2010adopts\u2010sepsis\u20103\u2010criteria\u2010claims\u2010validation."},{"key":"e_1_2_9_30_1","volume-title":"Coronavirus (COVID\u201019) Hospitalizations","author":"Mathieu E.","year":"2020"},{"key":"e_1_2_9_31_1","unstructured":"The American Hospital Association \u201cFast Facts on US Hospitals 2023 \u201dpublished May 2023 accessed March 25 2026 https:\/\/www.aha.org\/system\/files\/media\/file\/2023\/05\/Fast\u2010Facts\u2010on\u2010US\u2010Hospitals\u20102023.pdf."},{"key":"e_1_2_9_32_1","unstructured":"The American Hospital Association \u201cFast Facts on US Hospitals 2026 \u201dpublished January 2026 accessed March 25 2026 https:\/\/www.aha.org\/system\/files\/media\/file\/2026\/02\/Fast\u2010Facts\u2010on\u2010US\u2010Hospitals\u20102026.pdf."},{"key":"e_1_2_9_33_1","unstructured":"Blue Cross Blue Shield of Michigan \u201cHere's Our Sepsis DRG Reimbursement Policy. Blue Cross Blue Shield of Michigan \u201dpublished January 2025 accessed March 25 2026 https:\/\/www.bcbsm.com\/content\/dam\/microsites\/corpcomm\/provider\/the_record\/2025\/jan\/Record_0125j.html."},{"key":"e_1_2_9_34_1","unstructured":"Congressional Budget Office (CBO) \u201cFederal Budgetary Effects of the Activities of the Center for Medicare & Medicaid Innovation \u201dpublished September 2023 accessed March 25 2026 https:\/\/www.cbo.gov\/publication\/59274."},{"key":"e_1_2_9_35_1","unstructured":"National Center for Emerging and Zoonotic Infectious Diseases (U.S.) \u201cDivision of Healthcare Quality Promotion. Hospital Toolkit for Adult Sepsis Surveillance \u201dpublished May 2018 accessed March 25 2026 https:\/\/stacks.cdc.gov\/view\/cdc\/132387."},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2025.10218"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70135","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70135","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70135","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T13:53:40Z","timestamp":1782309220000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/1475-6773.70135"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70135","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70135"}}