Is sepsis accurately coded on hospital bills?

OBJECTIVE To examine whether sepsis is accurately coded on hospital bills. METHODS Hospital inpatient uniform bills (UB-92) for 122 patients with clinically documented severe sepsis of presumed infectious origin were retrospectively examined. Final UB-92 hospital bills were obtained for all study subjects. ICD-9-CM diagnosis codes from these bills were then reviewed to ascertain the number of subjects for whom one or more diagnostic codes for septicemia and/or bacteremia were present. RESULTS A total of 92 hospital bills (75.4%) contained one or more ICD-9-CM diagnostic codes for septicemia and/or bacteremia. Of the 30 that did not, 15 (12.3%) had codes for major systemic infection and organ failure. No diagnoses indicative of sepsis (i.e., organ failure and major infection) were present on the remaining 15 (12.3%) bills. CONCLUSIONS Our findings suggest that use of ICD-9-CM codes for identifying patients with sepsis using hospital bills is only moderately sensitive. Strict reliance on administrative data sources for sepsis surveillance or research planning may therefore be prone to substantial error.