The Great Sepsis War rages on; will we see a truce, or a winner?

By Brian Murphy

The Great Sepsis War rages on. The infection itself, which kills hundreds of thousands every year, but also in the hallowed halls of coding classification.

Where in the A41.9 will we end up with this deadly but controversial infection?

(aside: sepsis isn’t funny, but the rage elicited over conflicting definitions and the sheer volume of digital ink spilled on this dx is a bit humorous. You must know this).

I heard some folks say “game over” when the Government Accountability Office issued a report (see below) that seemed to champion sepsis-3.

Wrong.

Sepsis-2 still being used widely, for good reasons. It’s:

• Better at capturing early sepsis.
• Better aligned with CMS’s own sepsis core measure.

I hosted a frontline sepsis care nurse on Off the Record (link below, you should listen, fantastic episode) who confirmed the pressing clinical need to catch sepsis early before it comes a five-alarm fire—and just how much hospital resources are expended to treat a diagnosis that would not meet the strict qualifications of sepsis-3. Sepsis comprises a continuum for her organization, which still uses sepsis-2.

The debate rages on.

BUT… now we’ve got a big POSSIBLE (use of all caps deliberate) change afoot. Nothing has been approved, but a big proposal was made at an ICD-10-CM Coordination and Maintenance Committee Meeting earlier this year.

This change attempts to end the Great Sepsis War by moving us firmly into the sepsis-3 camp, while also addressing the issue of impending/early sepsis (which is a thing, caveat I’m not a clinician).

Link to the proposal below, see pp. 89-90. From that:

“It is proposed to create an expansion of sepsis codes, to identify (by organism) sepsis and impending sepsis, with at this time a single example given. Also, it is proposed to create codes to identify the organ dysfunction present, while also deleting the severe sepsis code and terminology, based on the definitional changes in Sepsis 3.”

We get proposed tabular modifications to just A41.9, but with the note that the same approach, if approved, would need to be applied to 40 additional sepsis codes. These include:

• Revise current A41.9, “Sepsis, unspecified organism” to read “Sepsis and impending sepsis, unspecified organism.”
• New code: A41.91, “Sepsis, specified organism” (many such specific examples listed).
• New code: A41.92, “Impending sepsis, unspecified organism.”

The proposal also calls for a revision to R65.2, “Severe sepsis,” as follows:

• 2, “Organ dysfunction associated with sepsis.”
• Proposed deletion: R65.20, “Severe sepsis without septic shock.”
• Proposed revision: R65.21, currently “severe sepsis with septic shock,” revise to “Septic shock.”

Some are opposed, saying that the Cooperating Parties should not be in the business of practicing medicine, and that this is a bridge too far.

I think this might be a good fix, for reasons noted above. but I also could be wrong.

As always, I welcome your comments at brian.murphy@norwood.com.

References

• CDC, ICD-10 Coordination and Maintenance Committee Meeting, March 17-18, 2026 ICD-10-CM Diagnosis Agenda: https://www.cdc.gov/nchs/data/icd/topic-packet-March-2026.pdf (see pp. 89-90)
• GAO, Defense Health Care: Information on Sepsis Incidence and Management: https://www.gao.gov/assets/gao-25-107357.pdf
• Off the Record podcast, Decoding Sepsis: A Clinical Nurse Specialist’s Frontline Perspective: https://podcasts.apple.com/us/podcast/decoding-sepsis-a-clinical-nurse-specialists/id1641739619?i=1000654167911