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A54.86 ICD-10-CM Code: Gonococcal sepsis

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

Coding at a Glance

Tabular directives
2 Excludes1 · 1 Excludes2
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 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)

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 A54.86 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 A54.86 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 A50-A64

Excludes2 — Not Included Here

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

Source: inherited from A50-A64

Coder workflow for A54.86

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

Before you code A54.86

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with A54.86. 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 A54.86’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.

    ReviewN34.1, M02.3

Consider A54.86. 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).

Official instructions as workflow

  • Excludes1 — check before selecting A54.86(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with A54.86: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareN34.1, M02.3

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

  • Excludes2 — not part of A54.86(1 note)

    Coding workflow: The conditions named in this note are not included in A54.86. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareB20

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

Coding decision scenarios

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

Documentation: Both the condition A54.86 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).

ReviewN34.1, M02.3

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

Gonococcal sepsis is a billable ICD-10-CM diagnosis code (A54.86).

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 (2)

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.

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 A54.86 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 8 Excludes2 notes across 3 chapters: A41 — Other sepsis, N34 — Urethritis and urethral syndrome (via A54.-), P35 — Congenital viral diseases (via A54.-), P35-P39 — Infections specific to the perinatal period (P35-P39) (via A54.-), P36 — Bacterial sepsis of newborn (via A54.-), P37 — Other congenital infectious and parasitic diseases (via A54.-), P38 — Omphalitis of newborn (via A54.-), P39 — Other infections specific to the perinatal period (via A54.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

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.

Named in the grouper logic of 3 MS-DRGs: DRG 870 (MDC 18), DRG 871 (MDC 18), DRG 872 (MDC 18).

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); INF010 — Sexually transmitted infections (excluding HIV and hepatitis).

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.

A41.89 — Other specified sepsis, 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, A49.3 — Mycoplasma infection, unspecified site, A49.8 — Other bacterial infections of unspecified site, A49.9 — Bacterial infection, unspecified, B00.7 — Disseminated herpesviral disease, B37.7 — Candidal sepsis, B92 — Sequelae of leprosy, B94.2 — Sequelae of viral hepatitis, B94.8 — Sequelae of other specified infectious and parasitic diseases, B94.9 — Sequelae of unspecified infectious and parasitic disease, +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.

A41.51 — 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, A41.89 — Other specified sepsis, A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis, A48.3 — Toxic shock syndrome, 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, P36.19 — Sepsis of newborn due to other streptococci, P36.2 — Sepsis of newborn due to Staphylococcus aureus, P36.30 — Sepsis of newborn due to unspecified staphylococci, P36.39 — Sepsis of newborn due to other staphylococci, +31 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Septicemia, Sexually transmitted infections (excluding HIV and hepatitis)).

A54.42 — Gonococcal arthritis, A54.43 — Gonococcal osteomyelitis, A54.49 — Gonococcal infection of other musculoskeletal tissue, A54.5 — Gonococcal pharyngitis, A54.6 — Gonococcal infection of anus and rectum, A54.81 — Gonococcal meningitis, A54.82 — Gonococcal brain abscess, A54.83 — Gonococcal heart infection, A54.84 — Gonococcal pneumonia, A54.85 — Gonococcal peritonitis, A54.89 — Other gonococcal infections, A54.9 — Gonococcal infection, unspecified, A55 — Chlamydial lymphogranuloma (venereum), A56.00 — Chlamydial infection of lower genitourinary tract, unspecified, A56.01 — Chlamydial cystitis and urethritis, A56.02 — Chlamydial vulvovaginitis, A56.09 — Other chlamydial infection of lower genitourinary tract, A56.11 — Chlamydial female pelvic inflammatory disease, A56.19 — Other chlamydial genitourinary infection, A56.2 — Chlamydial infection of genitourinary tract, unspecified, +189 more

Same Index main term, other category

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

A41.50 — Gram-negative sepsis, unspecified (Gram-negative), A41.51 — Sepsis due to Escherichia coli [E. coli] (Escherichia coli), A41.52 — Sepsis due to Pseudomonas (Pseudomonas), A41.53 — Sepsis due to Serratia (Serratia), A41.54 — Sepsis due to Acinetobacter baumannii (Acinetobacter baumannii), A41.59 — Other Gram-negative sepsis (Cronobacter), A41.81 — Sepsis due to Enterococcus (Enterococcus), A41.89 — Other specified sepsis (specified organism NEC), A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis (actinomycotic), B00.7 — Disseminated herpesviral disease (herpesviral), B37.7 — Candidal sepsis (candidal), J95.02 — Infection of tracheostomy stoma (tracheostomy stoma), K65.1 — Peritoneal abscess (intra-abdominal), O08.0 — Genital tract and pelvic infection following ectopic and molar pregnancy (following, abortion), O08.82 — Sepsis following ectopic and molar pregnancy (with, ectopic or molar pregnancy), O75.3 — Other infection during labor (during labor), O85 — Puerperal sepsis (puerperal, postpartum, childbirth), O86.04 — Sepsis following an obstetrical procedure (following, obstetrical procedure), P36.0 — Sepsis of newborn due to streptococcus, group B (newborn, due to, Streptococcus, group B), +58 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.

HIV Screening Test

Contextual Map

Every relationship of A54.86 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 A54.86 with these 8 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

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 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

  • Gonococcemia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Sepsis (generalized) (unspecified organism), gonococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (36)

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
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. "A54.86 — Gonococcal sepsis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/a54.86-gonococcal-sepsis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Gonococcal 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 A54.86 in its code family, with their registry titles.

View all codes in the A54 family