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. Author manuscript; available in PMC: 2016 Aug 1.
Published in final edited form as: JAMA. 2016 Feb 23;315(8):801–810. doi: 10.1001/jama.2016.0287

Table 2.

Terminology and International Classification of Diseases Coding

Current Guidelines
and Terminology		 Sepsis Septic Shock
1991 and 2001
consensus
terminology9,10 		Severe sepsis
Sepsis-induced
hypoperfusion		 Septic shock13
2015 Definition Sepsis is
life-threatening organ
dysfunction caused by a
dysregulated host
response to infection		 Septic shock is a subset of
sepsis in which underlying
circulatory and
cellular/metabolic
abnormalities are profound
enough to substantially
increase mortality
2015 Clinical
criteria		 Suspected or
documented infection
and
an acute increase of ≥2
SOFA points (a proxy
for organ dysfunction)		 Sepsisa
and
vasopressor therapy needed to
elevate MAP ≥65 mm Hg
and
lactate >2 mmol/L (18 mg/dL)
despite adequate fluid
resuscitation13
Recommended
primary ICD
codesa
  ICD-9 995.92 785.52
  ICD-10a R65.20 R65.21
Framework for
implementation
for coding and
research		 Identify suspected infection by using concomitant orders
for blood cultures and antibiotics (oral or parenteral) in a
specified periodb
Within specified period around suspected infectionc:
1. Identify sepsis by using a clinical criterion for
life-threatening organ dysfunction
2. Assess for shock criteria, using administration of
vasopressors, MAP <65 mm Hg, and lactate >2 mmol/L
(18 mg/dL)d

Abbreviations: ICD, International Classification of Diseases; MAP, mean arterial pressure; SOFA, Sequential [Sepsis-related] Organ Failure Assessment.27

a

Included training codes.

b

Suspected infection could be defined as the concomitant administration of oral or parenteral antibiotics and sampling of body fluid cultures (blood, urine, cerebrospinal fluid, peritoneal, etc). For example, if the culture is obtained, the antibiotic is required to be administered within 72 hours, whereas if the antibiotic is first, the culture is required within 24 hours.12

c

Considers a period as great as 48 hours before and up to 24 hours after onset of infection, although sensitivity analyses have tested windows as short as 3 hours before and 3 hours after onset of infection.12

d

With the specified period around suspected infection, assess for shock criteria, using any vasopressor initiation (eg, dopamine, norepinephrine, epinephrine, vasopressin, phenylephrine), any lactate level >2 mmol/L (18mg/dL), and mean arterial pressure <65mmHg. These criteria require adequate fluid resuscitation as defined by the Surviving Sepsis Campaign guidelines.4