R78.81 ICD-10-CM Code: Bacteremia

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R78.81 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 R78.81 itself; “inherited from” names the category or block whose note applies here.

This page already reflects the FY2027 tabular note taking effect October 1, 2026.

Coder workflow for R78.81

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

Before you code R78.81

1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

   Guide: Symptom code vs confirmed diagnosis →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with R78.81. 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. Is an established diagnosis that explains this sign or symptom documented?
   Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
   No → Continue — the sign or symptom code stands when no definitive diagnosis is established.
2. Does the documentation support a condition named in R78.81’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.

Consider R78.81. Then work the Use Additional Code note, and 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 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

• Excludes1 — check before selecting R78.81(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with R78.81: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

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

• Excludes2 — not part of R78.81(8 notes)

  Coding workflow: The conditions named in this note are not included in R78.81. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareO28, E78, D69

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

• Use Additional Code — after identifying R78.81(1 note)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with R78.81 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

  ReviewZ18

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

Coding decision scenarios

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

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.

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.

• Bacteremia
• Findings, abnormal, inconclusive, without diagnosis, culture, blood
• Positive, culture (nonspecific), blood

Don’t confuse R78.81 with…

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

The codes most likely to be picked instead of R78.81 — 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.

• F10— 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 mental or behavioral disorders due to psychoactive substance use adds F10; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs F10 →

• F19— 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 mental or behavioral disorders due to psychoactive substance use adds F19; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs F19 →

• O28— 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 abnormal findings on antenatal screening of mother adds O28; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs O28 →

• E78— 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 abnormalities of lipids adds E78; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs E78 →

• D69— 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 abnormalities of platelets and thrombocytes adds D69; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs D69 →

• D70— 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 abnormalities of white blood cells classified elsewhere adds D70; it is not part of this code and both may be reported when both are documented.

  Full comparison: R78.81 vs D70 →

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.

Decision Points

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

1. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 8 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

• CC 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 R78.81 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: A41 — Other sepsis, A49.9 — Bacterial infection, unspecified.

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

Referenced by 8 Excludes2 notes: R83 — Abnormal findings in cerebrospinal fluid (via R78.-), R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89) (via R78.-), R84 — Abnormal findings in specimens from respiratory organs and thorax (via R78.-), R85 — Abnormal findings in specimens from digestive organs and abdominal cavity (via R78.-), R86 — Abnormal findings in specimens from male genital organs (via R78.-), R87 — Abnormal findings in specimens from female genital organs (via R78.-), R88 — Abnormal findings in other body fluids and substances (via R78.-), R89 — Abnormal findings in specimens from other organs, systems and tissues (via R78.-).

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

Referenced by 1 Use Additional Code instruction: Z02.83 — Encounter for blood-alcohol and blood-drug test (via R78.-).

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: CC — 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 61 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 791 (MDC 15), DRG 793 (MDC 15), 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):SYM017 — Abnormal findings without diagnosis (default).

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 CC — 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.

R69 — Illness, unspecified, R70.1 — Abnormal plasma viscosity, R77.0 — Abnormality of albumin, R77.1 — Abnormality of globulin, R77.2 — Abnormality of alphafetoprotein, R77.8 — Other specified abnormalities of plasma proteins, R77.9 — Abnormality of plasma protein, unspecified, R78.1 — Finding of opiate drug in blood, R78.2 — Finding of cocaine in blood, R78.3 — Finding of hallucinogen in blood, R78.4 — Finding of other drugs of addictive potential in blood, R78.5 — Finding of other psychotropic drug in blood, R78.6 — Finding of steroid agent in blood, R78.9 — Finding of unspecified substance, not normally found in blood, R79.1 — Abnormal coagulation profile, R79.81 — Abnormal blood-gas level, R79.82 — Elevated C-reactive protein (CRP), R79.89 — Other specified abnormal findings of blood chemistry, R97.20 — Elevated prostate specific antigen [PSA], R97.21 — Rising PSA following treatment for malignant neoplasm of prostate, +40 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Abnormal findings without diagnosis).

R76.81 — Abnormal rheumatoid factor and anti-citrullinated protein antibody without rheumatoid arthritis, R76.89 — Other specified abnormal immunological findings in serum, R76.9 — Abnormal immunological finding in serum, unspecified, R77.0 — Abnormality of albumin, R77.1 — Abnormality of globulin, R77.2 — Abnormality of alphafetoprotein, R77.8 — Other specified abnormalities of plasma proteins, R77.9 — Abnormality of plasma protein, unspecified, R78.71 — Abnormal lead level in blood, R78.79 — Finding of abnormal level of heavy metals in blood, R78.89 — Finding of other specified substances, not normally found in blood, R78.9 — Finding of unspecified substance, not normally found in blood, R79.0 — Abnormal level of blood mineral, R79.1 — Abnormal coagulation profile, R79.81 — Abnormal blood-gas level, R79.82 — Elevated C-reactive protein (CRP), R79.83 — Abnormal findings of blood amino-acid level, R79.89 — Other specified abnormal findings of blood chemistry, R79.9 — Abnormal finding of blood chemistry, unspecified, R81 — Glycosuria, +183 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Findings, abnormal, inconclusive, without diagnosis”, “Positive”; these codes share that main term but sit in a different category of the Tabular List.

R71.0 — Precipitous drop in hematocrit (hematocrit drop), R71.8 — Other abnormality of red blood cells (anisocytosis), R73.09 — Other abnormal glucose (glucose), R73.9 — Hyperglycemia, unspecified (blood sugar, high), R74.01 — Elevation of levels of liver transaminase levels (SGPT), R74.02 — Elevation of levels of lactic acid dehydrogenase [LDH] (lactic acid dehydrogenase), R75 — Inconclusive laboratory evidence of human immunodeficiency virus [HIV] (test, human immunodeficiency virus), R76.0 — Raised antibody titer (antibody titer, elevated), R76.11 — Nonspecific reaction to tuberculin skin test without active tuberculosis (PPD), R76.89 — Other specified abnormal immunological findings in serum (serology for syphilis, false), R79.89 — Other specified abnormal findings of blood chemistry (liver function test), R81 — Glycosuria (glycosuria), R82.0 — Chyluria (chyluria), R82.1 — Myoglobinuria (myoglobinuria), R82.2 — Biliuria (urine, bile), R82.3 — Hemoglobinuria (hematinuria), R82.4 — Acetonuria (ketonuria), R82.5 — Elevated urine levels of drugs, medicaments and biological substances (catecholamines), R82.71 — Bacteriuria (bacteriuria), R82.79 — Other abnormal findings on microbiological examination of urine (culture, urine), +62 more

Contextual Map

Every relationship of R78.81 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 R78.81 with these 11 related codes in Claim Check

Hierarchy

• R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R70-R79 — Abnormal findings on examination of blood, without diagnosis[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• A41 — Other sepsis[Excludes1]: “bacteremia NOS (R78.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• A49.9 — Bacterial infection, unspecified[Excludes1]: “bacteremia NOS (R78.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• R83 — Abnormal findings in cerebrospinal fluid[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R84 — Abnormal findings in specimens from respiratory organs and thorax[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R85 — Abnormal findings in specimens from digestive organs and abdominal cavity[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R86 — Abnormal findings in specimens from male genital organs[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R87 — Abnormal findings in specimens from female genital organs[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R88 — Abnormal findings in other body fluids and substances[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R89 — Abnormal findings in specimens from other organs, systems and tissues[Excludes2](via R78.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Use Additional Code instructions

• Z02.83 — Encounter for blood-alcohol and blood-drug test[Use Additional Code](via R78.-): “code for findings of alcohol or drugs in blood (R78.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• SYM017 — Abnormal findings without diagnosis[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 791 — PREMATURITY WITH MAJOR PROBLEMS[MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• 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) · FY2026
• DRG 870 — SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS[MS-DRG]: “SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 871 — SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC[MS-DRG]: “SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 872 — SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC[MS-DRG]: “SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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

• Bacteremia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Findings, abnormal, inconclusive, without diagnosis, culture, blood[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Positive, culture (nonspecific), blood[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (15)

• R78 — Findings of drugs and other substances, not normally found in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.0 — Finding of alcohol in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.1 — Finding of opiate drug in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.2 — Finding of cocaine in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.3 — Finding of hallucinogen in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.4 — Finding of other drugs of addictive potential in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.5 — Finding of other psychotropic drug in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R78.6 — Finding of steroid agent in blood[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 7 more

Change history (3)

• FY2027 — Use Additional Code note will be added[Change history]— CMS release files (code change ledger) · icd10cm-fy2027
• and 2 more

Real-World Coding Questions

Questions working coders have asked about this code, answered from official sources and reviewed by an editor.

• The blood culture is positive and the provider documents bacteremia. Can sepsis be coded instead? →

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

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R78.81 in its code family, with their registry titles.

• R78.4 — Finding of other drugs of addictive potential in blood
• R78.5 — Finding of other psychotropic drug in blood
• R78.6 — Finding of steroid agent in blood
• R78.7 — Finding of abnormal level of heavy metals in blood
• R78.71 — Abnormal lead level in blood
• R78.72 — Abnormal gadolinium level in blood
• R78.79 — Finding of abnormal level of heavy metals in blood
• R78.8 — Finding of other specified substances, not normally found in blood
• R78.89 — Finding of other specified substances, not normally found in blood
• R78.9 — Finding of unspecified substance, not normally found in blood

View all codes in the R78 family