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P36.5 ICD-10-CM Code: Sepsis of newborn due to anaerobes

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

Coding at a Glance

Tabular directives
1 inclusion term · 10 Excludes2 · 1 use-additional code
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 v44, Appendix B.

  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

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 P36.5 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 P36.5 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 P36.5

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

Before you code P36.5

  1. P36.5’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 →

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.

Official instructions as workflow

  • Excludes2 — not part of P36.5(10 notes)

    Coding workflow: The conditions named in this note are not included in P36.5. 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 P36.5(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with P36.5 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: Only one of the components this code’s title joins is documented.

Coding question: Is P36.5 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 P36.5?

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 P36.5 with…

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

The codes most likely to be picked instead of P36.5 — 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.

  • P36.1— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Sepsis of newborn due to other and unspecified streptococci” takes P36.1; specificity in the record moves it back here.

    Full comparison: P36.5 vs P36.1 →

  • 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: P36.5 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: P36.5 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: P36.5 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: P36.5 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: P36.5 vs B20 →

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.

Code Overview

Sepsis of newborn due to anaerobes is a billable ICD-10-CM diagnosis code (P36.5).

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.

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 16: Certain Conditions Originating in the Perinatal Period (P00-P96)

f. Bacterial Sepsis of Newborn Category P36, Bacterial sepsis of newborn, includes congenital sepsis. If a perinate is documented as having sepsis without documentation of congenital or community acquired, the default is congenital and a code from category P36 should be assigned. If the P36 code includes the causal organism, an additional code from category B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, should not be assigned. If the P36 code does not include the causal organism, assign an additional code from category B96. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2027). 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 P36.5 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 1 Excludes1 note: 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.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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 48 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 791 (MDC 15), DRG 793 (MDC 15).

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

Clinical classification (AHRQ CCSR):PNL009 — Perinatal infections (default); INF002 — Septicemia; 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.

P29.4 — Transient myocardial ischemia in newborn, P29.89 — Other cardiovascular disorders originating in the perinatal period, P29.9 — Cardiovascular disorder originating in the perinatal period, unspecified, 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, P36.4 — Sepsis of newborn due to Escherichia coli, P36.8 — Other bacterial sepsis of newborn, P36.9 — Bacterial sepsis of newborn, unspecified, P37.5 — Neonatal candidiasis, P38.1 — Omphalitis with mild hemorrhage, P38.9 — Omphalitis without hemorrhage, P39.0 — Neonatal infective mastitis, P39.1 — Neonatal conjunctivitis and dacryocystitis, P39.2 — Intra-amniotic infection affecting newborn, not elsewhere classified, P39.3 — Neonatal urinary tract infection, P39.4 — Neonatal skin infection, +27 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.

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, P36.4 — Sepsis of newborn due to Escherichia coli, P36.8 — Other bacterial sepsis of newborn, P36.9 — Bacterial sepsis of newborn, unspecified, R57.1 — Hypovolemic shock, R57.8 — Other shock, R65.10 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction, R65.11 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction, R65.20 — Severe sepsis without septic shock, R65.21 — Severe sepsis with septic shock, T79.4XXA — Traumatic shock, initial encounter, +31 more

Same clinical category (CCSR)

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

P35.4 — Congenital Zika virus disease, P35.8 — Other congenital viral diseases, P35.9 — Congenital viral disease, unspecified, 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, P36.4 — Sepsis of newborn due to Escherichia coli, P36.8 — Other bacterial sepsis of newborn, P36.9 — Bacterial sepsis of newborn, unspecified, P37.0 — Congenital tuberculosis, P37.1 — Congenital toxoplasmosis, P37.2 — Neonatal (disseminated) listeriosis, P37.3 — Congenital falciparum malaria, P37.4 — Other congenital malaria, P37.5 — Neonatal candidiasis, P37.8 — Other specified congenital infectious and parasitic diseases, P37.9 — Congenital infectious or parasitic disease, unspecified, +452 more

Same Index main term, other category

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

P08.21 — Post-term newborn (post-term), P08.22 — Prolonged gestation of newborn (prolonged gestation), P28.2 — Cyanotic attacks of newborn (affected by, cyanosis), P28.30 — Primary sleep apnea of newborn, unspecified (apnea, sleep), P28.40 — Unspecified apnea of newborn (apnea), P28.42 — Obstructive apnea of newborn (apnea, obstructive), P28.81 — Respiratory arrest of newborn (affected by, respiratory arrest), P29.11 — Neonatal tachycardia (affected by, heart rate abnormalities, tachycardia), P29.12 — Neonatal bradycardia (affected by, heart rate abnormalities, bradycardia), P29.81 — Cardiac arrest of newborn (affected by, cardiac arrest), P37.5 — Neonatal candidiasis (infection, candidal), P38.1 — Omphalitis with mild hemorrhage (omphalitis, with mild hemorrhage), P38.9 — Omphalitis without hemorrhage (omphalitis), P39.0 — Neonatal infective mastitis (mastitis), P39.3 — Neonatal urinary tract infection (infection, urinary tract), P39.8 — Other specified infections specific to the perinatal period (infection, specified NEC), P39.9 — Infection specific to the perinatal period, unspecified (infection), P50.0 — Newborn affected by intrauterine (fetal) blood loss from vasa previa (affected by, vasa previa, from intrauterine blood loss), P50.1 — Newborn affected by intrauterine (fetal) blood loss from ruptured cord (affected by, intrauterineblood loss, due to, ruptured cord blood), P50.2 — Newborn affected by intrauterine (fetal) blood loss from placenta (affected by, intrauterineblood loss, due to, placenta), +208 more

Contextual Map

Every relationship of P36.5 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 P36.5 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

  • A41 — Other sepsis[Excludes1](via P36.-): “neonatal (P36.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

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

  • MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 791 — PREMATURITY WITH MAJOR PROBLEMS[MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
  • DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS[MS-DRG]: “FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

Index entries

  • Newborn (infant) (liveborn) (singleton), sepsis (congenital), due to, anaerobes NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Sepsis (generalized) (unspecified organism), newborn, due to, anaerobes NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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

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
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section 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
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 — v44 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. "P36.5 — Sepsis of newborn due to anaerobes." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/p36.5-sepsis-of-newborn-due-to-anaerobes

Change history

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

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 P36.5 in its code family, with their registry titles.

View all codes in the P36 family