Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

Sepsis (clinical validation; Sepsis-3 and Sepsis-2 shown side by side)

Rule sepsis version 2026.11-1 · condition: Sepsis

Published source

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), Singer et al., JAMA 2016;315:801-810 (2016). Boxes 3-4: sepsis = infection + acute change in total SOFA >=2 (baseline 0 unless known); septic shock = vasopressors for MAP >=65 and lactate >2 mmol/L despite adequate volume. https://jamanetwork.com/journals/jama/fullarticle/2492881 · public page checked 2026-11-14

Also: Sepsis-2 / 1991-2001 consensus (SIRS), as restated in Sepsis-3 Box 1 (2001). SIRS >=2 of: temperature >38 or <36 C; HR >90; RR >20 or PaCO2 <32 mmHg; WBC >12 or <4 x10^3/uL or >10% bands. Sepsis = SIRS + infection; severe sepsis = sepsis + organ dysfunction. link

Also: CMS SEP-1 measure (v5.17a): severe sepsis = infection + >=2 SIRS criteria + organ dysfunction within 6 hours (2025). CMS national provider call slides, April 2025. link

Contested or local convention. CONTESTED DEFINITIONS. Sepsis-3 (organ dysfunction, SOFA) is the current consensus definition; Sepsis-2 (SIRS) is still used by the CMS SEP-1 quality measure and by many payers' clinical-validation policies. When the two disagree this rule never concludes: it returns "clinical judgement required (definition-dependent)". ICD-10-CM guideline I.A.19: code assignment is based on the provider's statement, not on clinical criteria; clinical validation is a separate process. The rule validates documented sepsis only and never prompts for an undocumented sepsis diagnosis.

Inputs

infection_documented: Infection quoted from a note or an infection principal diagnosis
temp_max_48h: Highest temperature, first 48 h (C)
temp_min_48h: Lowest temperature, first 48 h (C)
hr_max_48h: Highest heart rate, first 48 h
rr_max_48h: Highest respiratory rate, first 48 h
paco2_min_48h: Lowest PaCO2, first 48 h (mmHg)
wbc_max_48h: Highest WBC, first 48 h (x10^3/uL)
wbc_min_48h: Lowest WBC, first 48 h (x10^3/uL)
bands_max_48h: Highest bands, first 48 h (%)
pf_min_48h: Lowest PaO2/FiO2, first 48 h
adv_resp_support: High-flow, non-invasive or invasive ventilation
platelets_min_48h: Lowest platelets, first 48 h (x10^3/uL)
bili_max_48h: Highest bilirubin, first 48 h (mg/dL)
map_min_48h: Lowest mean arterial pressure, first 48 h (mmHg)
norepi_max_48h: Highest norepinephrine-equivalent dose, first 48 h (mcg/kg/min)
gcs_min_48h: Lowest Glasgow Coma Scale, first 48 h
creat_max_48h: Highest creatinine, first 48 h (mg/dL)
creat_baseline: Baseline creatinine (mg/dL), for the baseline renal SOFA score
lactate_max_48h: Highest lactate, first 48 h (mmol/L)

Thresholds

t.t_hi: 38
t.t_lo: 36
t.hr: 90
t.rr: 20
t.paco2: 32
t.wbc_hi: 12
t.wbc_lo: 4
t.bands: 10
t.sirs_min: 2
t.sofa_delta: 2
t.lactate: 2

Derived values

Evaluated in order
Name	Expression
sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`
sirs_hr	`coalesce(hr_max_48h > t.hr, false)`
sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`
sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`
sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`
sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`
sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`
sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`
sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`
sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`
sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`
sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`
sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`
sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`
sepsis2	`infection_documented and sirs_count >= t.sirs_min`
shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`

Outcomes

First true outcome wins; an unknown input makes an outcome unknown
Outcome	When	Status	Supports
no_infection No documented infection; both definitions require one	`not infection_documented`	not_supported	—
septic_shock Sepsis-3 septic shock: SOFA change {sofa_delta}, vasopressor and lactate {lactate_max_48h}	`shock`	supported	R65.21 Sepsis with septic shock
both Both definitions met: SOFA change {sofa_delta} (Sepsis-3) and {sirs_count} SIRS criteria (Sepsis-2)	`sepsis3 and sepsis2`	supported	A41.9 Sepsis Severe sepsis (R65.20) also requires the clinician to link the organ dysfunction to the sepsis.
sepsis3_only Sepsis-3 met (SOFA change {sofa_delta}); only {sirs_count} SIRS criteria (Sepsis-2 not met)	`sepsis3`	supported	A41.9 Sepsis (Sepsis-3) Meets the current consensus definition; a SIRS-based (Sepsis-2) reviewer could disagree.
definitions_disagree Definition-dependent: {sirs_count} SIRS criteria (Sepsis-2 met) but SOFA change only {sofa_delta} (Sepsis-3 not met)	`sepsis2`	judgement	—
neither Neither definition met: {sirs_count} SIRS criteria, SOFA change {sofa_delta}	`true`	not_supported	—

ICD-10-CM specificity ladder (FY2026 CC/MCC status as a secondary diagnosis)

A41.9 Sepsis, unspecified organism · MCC
R65.20 Severe sepsis without septic shock · MCC (refines A41.9)
R65.21 Severe sepsis with septic shock · MCC (refines R65.20)

Query topic: infection-related documentation · prompts for an undocumented diagnosis: no

Where clinical judgement is required

SIRS and SOFA inputs use the first 48 hours after admission (a simplification of "simultaneous" criteria).
Baseline SOFA is assumed 0 except renal, which uses the pre-admission creatinine when known.
Missing SOFA components score 0 (as in the source's convention when data are absent); this can understate dysfunction.
Whether organ dysfunction is caused by the infection or by something else is a clinician judgement.