Who Owns Sepsis? The Battle to Define a Deadly Condition

CDI, coding, and clinical medicine are involved in a tug-of-war over a complex, life-threatening medical emergency that seems resistant to all forms of consensus. I'm talking about sepsis of course, and on today’s show I got to talk about sepsis with someone as qualified as anyone in the world to do so. Steven Simpson, MD, is Professor of Medicine at the University of Kansas in the Division of Pulmonary, Critical Care, and Sleep Medicine. He has done research in all areas of severe sepsis, from molecular and cellular mechanisms to translational and quality improvement studies. He is currently chair of the board of directors for the Sepsis Alliance and an author of the 2016, 2021, and 2025 reviews and updates of the Surviving Sepsis Campaign Guidelines. I’m also joined by James Kennedy, MD, CCS, a familiar name and voice for anyone involved in CDI and coding circles. Listen in as we cover: Dr. Simpson’s deep and rich background in sepsis, including early clinical days with septic patients, working with Drs. Bone and Balk who created Sepsis-1, and his role on the Sepsis Alliance. Co-authoring the 2026 Surviving Sepsis Guideline that defines sepsis as a “life-threatening acute organ dysfunction to infection”: His stance on sepsis-2 and sepsis-3. The politics of definition and diagnosis: Who gets to write these definitions. The struggle: Reconciling sepsis-2 with sepsis-3, further complicated by CMS’ use of sepsis-2 in its new sepsis readmission measure. What’s the right answer for this, if there is one? Looming sepsis proposal to create codes for “impending sepsis,” the role of AI-technologies (e.g., Sepsis ImmunoScore, TriVerity) in identifying these patients, and what the University of Kansas is doing to identify and intervene on infected patients before they evolve into organ dysfunctions. Plans for future work for other sepsis-related concepts, payers and denials, and a pair of songs for the Off the Record Spotify playlist.