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A41.89 ICD-10-CM Code: Other specified sepsis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
4 Excludes1 · 13 Excludes2 · 6 code-first instructions
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 2

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 870 — SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS (MDC 18)
  • MS-DRG 871 — SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC (MDC 18)
  • MS-DRG 872 — SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC (MDC 18)
  • MS-DRG 974 — HIV WITH MAJOR RELATED CONDITION WITH MCC (MDC 25)
  • MS-DRG 975 — HIV WITH MAJOR RELATED CONDITION WITH CC (MDC 25)
  • MS-DRG 976 — HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC (MDC 25)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock

Other models: CMS-HCC V22 HCC 2

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for A41.89 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on A41.89 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from A41

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from A41

Code First

Underlying conditions that must be sequenced before this code.

  • Code first, if applicable, postprocedural sepsis (T81.44-)
  • sepsis due to central venous catheter (T80.211-)
  • sepsis during labor (O75.3)
  • sepsis following abortion, ectopic or molar pregnancy (O03.37, O03.87, O04.87, O07.37, O08.82)
  • sepsis following immunization (T88.0-)
  • sepsis following infusion, transfusion or therapeutic injection (T80.22-, T80.29-)

Source: inherited from A41

Coder workflow for A41.89

MedCoder structured workflow — derived from this code’s own official record

Before you code A41.89

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on A41.89; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewA41.81

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with A41.89. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in A41.89’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewR78.81, P36, O85, A40

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then A41.89.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewT81.44, T80.211, O75.3, O03.37, O03.87, O04.87

Consider A41.89. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting A41.89(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with A41.89: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareR78.81, P36, O85, A40

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of A41.89(13 notes)

    Coding workflow: The conditions named in this note are not included in A41.89. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareA42.7, A22.7, B37.7, A26.7, A28.2, A54.86

    See the official tabular notes · Guidelines I.A.12.b

  • Code First — sequencing check(6 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before A41.89. Do not add an underlying condition the record does not document.

    ReviewT81.44, T80.211, O75.3, O03.37, O03.87, O04.87

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition A41.89 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewR78.81, P36, O85, A40

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewT81.44, T80.211, O75.3, O03.37, O03.87, O04.87

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Other specified sepsis is a billable ICD-10-CM diagnosis code (A41.89).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

k. Puerperal sepsis Code O85, Puerperal sepsis, should be assigned with a secondary code to identify the causal organism (e.g., for a bacterial infection, assign a code from category B95-B96, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Sequencing: 6 Code First instructions — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 4 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 13 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name A41.89 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Code First instructions across 2 chapters: I5A — Non-ischemic myocardial injury (non-traumatic) (via A41.-), N08 — Glomerular disorders in diseases classified elsewhere (via A41.-), N16 — Renal tubulo-interstitial disorders in diseases classified elsewhere (via A41.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 6 Use Additional Code instructions across 2 chapters: J95.02 — Infection of tracheostomy stoma (via A41.-), K94.02 — Colostomy infection (via A41.-), K94.12 — Enterostomy infection (via A41.-), K94.22 — Gastrostomy infection (via A41.-), K95.01 — Infection due to gastric band procedure (via A41.-), K95.81 — Infection due to other bariatric procedure (via A41.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 46 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 974-976 (HIV with Major Related Condition).

Named in the grouper logic of 8 MS-DRGs: DRG 791 (MDC 15), DRG 793 (MDC 15), DRG 870 (MDC 18), DRG 871 (MDC 18), DRG 872 (MDC 18), DRG 974 (MDC 25), DRG 975 (MDC 25), DRG 976 (MDC 25).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INF002 — Septicemia (default); INF003 — Bacterial infections.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

A41.2 — Sepsis due to unspecified staphylococcus, A41.3 — Sepsis due to Hemophilus influenzae, A41.4 — Sepsis due to anaerobes, A41.50 — Gram-negative sepsis, unspecified, A41.51 — Sepsis due to Escherichia coli [E. coli], A41.52 — Sepsis due to Pseudomonas, A41.53 — Sepsis due to Serratia, A41.54 — Sepsis due to Acinetobacter baumannii, A41.59 — Other Gram-negative sepsis, A41.81 — Sepsis due to Enterococcus, A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis, A48.2 — Nonpneumonic Legionnaires' disease [Pontiac fever], A48.3 — Toxic shock syndrome, A48.4 — Brazilian purpuric fever, A48.8 — Other specified bacterial diseases, A49.01 — Methicillin susceptible Staphylococcus aureus infection, unspecified site, A49.02 — Methicillin resistant Staphylococcus aureus infection, unspecified site, A49.1 — Streptococcal infection, unspecified site, A49.2 — Hemophilus influenzae infection, unspecified site, +25 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) for risk-adjusted payment.

A41.2 — Sepsis due to unspecified staphylococcus, A41.3 — Sepsis due to Hemophilus influenzae, A41.4 — Sepsis due to anaerobes, A41.50 — Gram-negative sepsis, unspecified, A41.51 — Sepsis due to Escherichia coli [E. coli], A41.52 — Sepsis due to Pseudomonas, A41.53 — Sepsis due to Serratia, A41.54 — Sepsis due to Acinetobacter baumannii, A41.59 — Other Gram-negative sepsis, A41.81 — Sepsis due to Enterococcus, A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis, A48.3 — Toxic shock syndrome, A54.86 — Gonococcal sepsis, B00.7 — Disseminated herpesviral disease, B37.7 — Candidal sepsis, M35.81 — Multisystem inflammatory syndrome, P02.70 — Newborn affected by fetal inflammatory response syndrome, P36.0 — Sepsis of newborn due to streptococcus, group B, P36.10 — Sepsis of newborn due to unspecified streptococci, +31 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Septicemia, Bacterial infections).

A41.2 — Sepsis due to unspecified staphylococcus, A41.3 — Sepsis due to Hemophilus influenzae, A41.4 — Sepsis due to anaerobes, A41.50 — Gram-negative sepsis, unspecified, A41.51 — Sepsis due to Escherichia coli [E. coli], A41.52 — Sepsis due to Pseudomonas, A41.53 — Sepsis due to Serratia, A41.54 — Sepsis due to Acinetobacter baumannii, A41.59 — Other Gram-negative sepsis, A41.81 — Sepsis due to Enterococcus, A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis, A54.86 — Gonococcal sepsis, B37.7 — Candidal sepsis, O03.37 — Sepsis following incomplete spontaneous abortion, O03.87 — Sepsis following complete or unspecified spontaneous abortion, O04.87 — Sepsis following (induced) termination of pregnancy, O07.37 — Sepsis following failed attempted termination of pregnancy, O08.82 — Sepsis following ectopic and molar pregnancy, O85 — Puerperal sepsis, +392 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Sepsis”, “Embolism”; these codes share that main term but sit in a different category of the Tabular List.

A32.7 — Listerial sepsis (Listeria monocytogenes), A39.1 — Waterhouse-Friderichsen syndrome (adrenal hemorrhage syndrome), A39.2 — Acute meningococcemia (meningococcal, acute), A39.3 — Chronic meningococcemia (meningococcal, chronic), A39.4 — Meningococcemia, unspecified (meningococcal), A40.0 — Sepsis due to streptococcus, group A (Streptococcus, streptococcal, group, A), A40.1 — Sepsis due to streptococcus, group B (Streptococcus, streptococcal, group, B), A40.3 — Sepsis due to Streptococcus pneumoniae (pneumococcal), A40.8 — Other streptococcal sepsis (Streptococcus, streptococcal, specified NEC), A40.9 — Streptococcal sepsis, unspecified (pyemic, streptococcal), A42.7 — Actinomycotic sepsis (actinomycotic), A54.86 — Gonococcal sepsis (gonococcal), B00.7 — Disseminated herpesviral disease (herpesviral), B37.7 — Candidal sepsis (candidal), E23.6 — Other disorders of pituitary gland (pituitary), G06.1 — Intraspinal abscess and granuloma (spinal cord, pyogenic origin), G08 — Intracranial and intraspinal phlebitis and thrombophlebitis (venous sinus), G95.19 — Other vascular myelopathies (spinal cord), H34.9 — Unspecified retinal vascular occlusion (eye), I24.0 — Acute coronary thrombosis not resulting in myocardial infarction (artery, coronary, not resulting in infarction), +165 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Gamma-glutamyl Transferase (GGT) Test

Contextual Map

Every relationship of A41.89 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run A41.89 with these 9 related codes in Claim Check

Hierarchy

Referenced by Code First instructions

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 18 — Infectious and Parasitic Diseases, Systemic or Unspecified Sites[MDC crossing]: “Infectious and Parasitic Diseases, Systemic or Unspecified Sites — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Embolism (multiple) (paradoxical), pyemic (multiple), specified organism NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pyemia, pyemic (fever) (infection) (purulent), specified organism NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Sepsis (generalized) (unspecified organism), specified organism NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (18)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "A41.89 — Other specified sepsis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/a41.89-other-specified-sepsis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other specified sepsis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to A41.89 in its code family, with their registry titles.

View all codes in the A41 family