Ben

Claim 23145678912 · 35 · billed charge $70,000

📄 Claim as submitted

Billed DRG

871

Sepsis w/o MV >96h — WITH MCC

Pays

$13,598

A41.9Sepsis, unspecified organismPDX

R65.20Severe sepsis without septic shockMCC

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.