P. Vasquez

Claim 72956140382 · 59 F · 5-day LOS · POS 21 · billed charge $40,700

📄 Claim as submitted

Billed DRG

871

Sepsis w/o MV >96h — WITH MCC

Pays

$13,598

A41.02Sepsis due to MRSAPDX

R65.21Severe sepsis with septic shockMCC

T80.211ABSI due to central venous catheter, initialCC

RW 1.9425 × $7,000 base · FY2026 V43.0

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Rate basis (FY2026 / V43.0): DRG 871 RW 1.9425 (verified CMS); DRG 872 RW 1.0299 (verified CMS FY2024); base $7,000 blended IPPS rate. Validation logic grounded in ICD-10-CM Official Guidelines §I.C.1.d, AHA Coding Clinic, UHDDS, and Sepsis-3 (Singer et al., JAMA 2016). This tool surfaces a recommendation for a human auditor and does not auto-adjudicate.