News: NCHS considers ICD-10-CM changes to embrace Sepsis-3 criteria, comments wanted

The National Center for Health Statistics (NCHS) proposed a broad revision of sepsis coding which would embrace Sepsis-3 criteria during the March 17–18 ICD-10 Coordination and Maintenance Committee meeting. The proposed changes would be applied to all approximately 40 codes for sepsis.

According to statements made at the meeting, NCHS is revisiting a previously rejected proposal to align coding guidelines with Sepsis-3 and Sequential Organ Failure Assessment (SOFA) criteria because it has been suggested by “unnamed parties” that the change could mean sepsis cases “would cost less.”

When the proposal was initially made in 2019, it was rejected based on negative public feedback. According to the Coordination and Maintenance Committee meeting agenda (pp. 89–90), some of the comments were related to the need for sepsis criteria for pediatric patients, which was addressed with the Phoenix criteria.

The new proposal, according to the agenda, would create expanded sepsis codes to identify the sepsis by organism and impending sepsis, create codes to identify the organ dysfunction present, and delete the code for severe sepsis and terminology based on the Sepsis-3 criteria.

ACDIS has received comments from members expressing concerns about these proposed changes. Specifically, some members have raised the concern that the expansion of the code set seems to be forcing the Sepsis-3 criteria when the code set is not meant to endorse any specific clinical criteria. Per the Official Guidelines for Coding and Reporting, code assignment is based on the clinician’s diagnostic statement rather than their adherence to a specific clinical criteria set.

The public has until May 15 to submit comments on updates being considered for implementation on April 1, 2027. NCHS noted that this sepsis proposal is meant to elicit public comments ahead of the September 2026 public meeting, during which a more formal presentation is expected; these changes are not likely to be finalized until at least 2027.

Editor’s note: To read the full ICD-10 Coordination and Maintenance Committee meeting agenda, including information about the proposed changes to sepsis coding, click here. To learn more about Coordination and Maintenance Committee meetings and access recordings of past meetings, click here.