Medicare Severity Diagnosis Related Groups (MS DRG) 870 Claims for Septicemia or Severe Sepsis

Policy Update #: POLMSDRG870092125

Effective Date: September 21, 2025

Current State: N/A

Future State: MS DRG 870 reports claims for septicemia or severe sepsis with mechanical ventilation greater than ninety-six hours. The edit will deny claims for MS DRG claims when the discharge status is not equal to (02,05,30,82,85) and reports with inpatient procedure code 5A0955A and the length of stay less than 96 hours.

Applicable Plan(s): Commercial and Medicare

Applicable Policy #: 4556 Diagnosis Related Groups (DRG) Computation

Business Owner: Network Management

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Medicare Severity Diagnosis Related Groups (MS DRG) 870 Claims for Septicemia or Severe Sepsis