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Wednesday, October 30, 2013

Faux Sepsis

We learned earlier that faux pneuonia is a type of pneumonia that exists only for billing purposes.  To make sure insurance and government auditors don't catch on to the cunning ways of medical quality assurance analyzers, the medical community had conceived another faux diagnosis, this time called faux sepsis.

Surely no doctor would admit to the diagnosis of faux pneumonia, so he simply writes "pneumonia" as the admitting diagnosis.  The same is true with faux sepsis.  In this case, the physician would write "SIRS" as the admitting diagnosis.

The official name is Systemic Inflammatory Response Syndrome.  It was first described in 1983 by Dr. Wiliam R. Nelson at the University of Toronto.  He described it as an inflammatory state of the whole system, and that it precludes multi system organ failure or full fledged sepsis.  He said it was essentially the systems response to an infection, such as pneumonia.  It is a serious condition that must be taken seriously.

The condition is typically dealt with by a hospital's sepsis protocol.  Any person who has any two of the following meets criteria for the sepsis protocol:

  • Heart rate greater than 100
  • Respiratory rate greater than 20
  • Fever greater than 101.4
The protocol consists of the following:
  • ABG to check for pH
  • Lactic acid to check for organ falure
  • Breathing treatment, if pneumonia is the suspected cause
  • Other
If the tests turn up positive, the person is diagnosed with sepsis.  If the tests turn up negative, but the patient looks sick enough to be admitted and you don't want to risk a lawsuit for sending a sick patient home, then you diagnose the patient with faux sepsis, or SIRS.  This assures that the patient meets reimbursement criteria. 

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