Claim. A five-day sepsis admission billed at MS-DRG 871: severe sepsis with two major complications.
Clinical picture. E. coli bacteremia with vasopressor-dependent shock and acute kidney injury, managed at ICU level of care.
Denial rationale. Anthem downgraded it to DRG 690, calling the hypotension dehydration and the AKI transient, underpaying by $19,370.
Fictitious sample cases for demonstration. Patient, provider, and clinical details are invented; only the payer names are real.
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