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P36.1 ICD-10-CM Code: Sepsis of newborn due to other and unspecified streptococci

Compare with another code for P36.1Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Tabular directives
1 inclusion term · 10 Excludes2 · 1 use-additional instruction

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codefrom P36Report with this code when documented
  • Use additional code(s), if applicable, to identify severe sepsis (R65.2-) and associated acute organ dysfunction(s)
Excludes2Not included here; may be reported together
  • asymptomatic human immunodeficiency virus [HIV] infection status (Z21) (from P35-P39)
  • congenital gonococcal infection (A54.-) (from P35-P39)
  • congenital pneumonia (P23.-) (from P35-P39)
  • congenital syphilis (A50.-) (from P35-P39)

+6 more in Instructions

Includesfrom P36What P36 covers
  • congenital sepsis

Where it sits Source: CMS/NCHS

Under:Chapter 16: Certain Conditions Originating in the Perinatal PeriodP35-P39 Infections specific to the perinatal periodP36 Bacterial sepsis of newborn

Codes under P36.1 (2)

  • P36.10Sepsis of newborn due to unspecified streptococciBillable
  • P36.19Sepsis of newborn due to other streptococciBillable

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P36.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on P36.1 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • congenital sepsis

Source: inherited from P36

Excludes2 — Not Included Here

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

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code(s), if applicable, to identify severe sepsis (R65.2-) and associated acute organ dysfunction(s)

Source: inherited from P36

Coder workflow for P36.1

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

Before you code P36.1

  1. P36.1 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewP36.10, P36.19

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. P36.1’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath P36.1?
    Yes → Select that code and continue the checks below on its own page.
    No → P36.1 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewP36.10, P36.19

Report the code beneath P36.1 that the documentation supports, not P36.1 itself. Then work the Use Additional Code note, and confirm that code is valid for the date of service on its own page.

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 associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Any detail beyond this code’s title
What the record states that a more specific code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of P36.1(10 notes)

    Coding workflow: The conditions named in this note are not included in P36.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareZ21, A54, P23, A50, B20, A48.51

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

  • Use Additional Code — after identifying P36.1(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with P36.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewR65.2

    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: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewP36.0, P36.2, P36.4, P36.5, P36.8

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is the code beneath P36.1 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with the code beneath P36.1?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewR65.2

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.

Don’t confuse P36.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of P36.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • Z21— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of asymptomatic human immunodeficiency virus [HIV] infection status adds Z21; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs Z21 →

  • A54— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of congenital gonococcal infection adds A54; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs A54 →

  • P23— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of congenital pneumonia adds P23; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs P23 →

  • A50— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of congenital syphilis adds A50; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs A50 →

  • B20— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of human immunodeficiency virus [HIV] disease adds B20; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs B20 →

  • A48.51— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of infant botulism adds A48.51; it is not part of this code and both may be reported when both are documented.

    Full comparison: P36.1 vs A48.51 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Sepsis of newborn due to other and unspecified streptococci is a non-billable ICD-10-CM category code (P36.1). A more specific billable subcode must be selected for claims submission.

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

Verify Before Coding

  • Not billable as written — a more specific code is required: P36.10, P36.19.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name P36.1 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 2 Excludes1 notes: A40 — Streptococcal sepsis, A41 — Other sepsis (via P36.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: P00.2 — Newborn affected by maternal infectious and parasitic diseases (via P36.-).

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

Contextual Map

Every relationship of P36.1 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 P36.1 with these 3 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

  • A40 — Streptococcal sepsis[Excludes1]: “neonatal (P36.0-P36.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027
  • A41 — Other sepsis[Excludes1](via P36.-): “neonatal (P36.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Excludes2 notes

Nearest codes (12)

Change history

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

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Can P36.1 be billed directly?

No. P36.1 (Sepsis of newborn due to other and unspecified streptococci) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "P36.1 — Sepsis of newborn due to other and unspecified streptococci." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/p36.1-sepsis-of-newborn-due-to-other-and-unspecified-streptococci

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Sepsis of newborn due to other and unspecified streptococci

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 P36.1 in its code family, with their registry titles.

View all codes in the P36 family