A26.7 ICD-10-CM Code: Erysipelothrix sepsis
A26.7 maps to CMS-HCC V28 2. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Certain zoonotic bacterial diseases (A20-A28)
A26.7
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceErysipelothrix sepsis
A serious bloodstream infection caused by the Erysipelothrix bacteria, which typically enters the body through cuts or wounds on the skin. This condition can spread throughout the body and cause severe systemic illness if not treated promptly with antibiotics.
Buddy Insight
Erysipelothrix sepsis is a rare bloodstream infection caused by Erysipelothrix rhusiopathiae, primarily affecting individuals with occupational exposure to animals, fish, or meat products.
CMS-HCC V28
MappedHCC 2
Coefficient HCC 2: 0.500 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 002
Code-level coefficient reference
ESRD/PACE
MappedHCC 2
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for A26.7. Check the code and parent instructions in the Code Book.
Excludes 2
Official- carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99
- infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99
- influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99
Related Codes
Includes
Official- diseases generally recognized as communicable or transmissibleInherited from A00-B99
Excludes 1
Official- certain localized infections - see body system-related chaptersInherited from A00-B99
Code First
OfficialNo Code First sequencing instructions are included in this display for A26.7. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99
Code Also
OfficialNo Code Also instructions are included in this display for A26.7. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is A26.7 an HCC code?
Yes. A26.7 (Erysipelothrix sepsis) maps to HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.500. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: A26.7 is billable and maps to V28 HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- A26.7
- Description
- Erysipelothrix sepsis
- HCC (V28)
- HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
- RAF reference coefficient
- 0.500
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work A26.7 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for A26.7
For A26.7, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
A26.7 is the ICD-10-CM diagnosis code for erysipelothrix sepsis. A serious bloodstream infection caused by the Erysipelothrix bacteria, which typically enters the body through cuts or wounds on the skin. This condition can spread throughout the body and cause severe systemic illness if not treated promptly with antibiotics. A26.7 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering certain zoonotic bacterial diseases (a20-a28).
Under the CMS-HCC V28 risk adjustment model, A26.7 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a source-labeled community, non-dual, aged reference coefficient of 0.500. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Verify that sepsis is documented in the medical record before assigning this code, as it indicates a systemic infection rather than localized erysipeloid. For A26.7, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A26.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that sepsis is documented in the medical record before assigning this code, as it indicates a systemic infection rather than localized erysipeloid
- •Check for any secondary codes related to the site of entry (such as wound infection) or any organ dysfunction that may have resulted from the sepsis
Clinical Significance
Erysipelothrix sepsis is a rare bloodstream infection caused by Erysipelothrix rhusiopathiae, primarily affecting individuals with occupational exposure to animals, fish, or meat products. The infection can cause endocarditis in up to 90% of sepsis cases, making cardiac evaluation essential.
Documentation Requirements
- ✓Blood cultures identifying Erysipelothrix rhusiopathiae
- ✓Documentation of sepsis criteria (SIRS/qSOFA with suspected infection source)
- ✓Occupational or exposure history (butchers, fishermen, veterinarians, poultry workers)
- ✓Echocardiogram results to evaluate for endocarditis (present in majority of Erysipelothrix sepsis cases)
- ✓Organ dysfunction assessment and severity documentation
Commonly Confused Codes
- •A46 (Erysipelas): Erysipelas is a superficial skin infection caused by Streptococcus, not Erysipelothrix; completely different organism and condition
- •A26.0 (Cutaneous erysipeloid): A26.0 is the localized skin infection (erysipeloid); A26.7 is systemic bloodstream infection
- •A41.89 (Other specified sepsis): Use A26.7 specifically when Erysipelothrix is identified, not the generic other sepsis code