A26.7
BillableErysipelothrix sepsis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is A26.7 an HCC code?
Yes. A26.7 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model (and Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for A26.7
For A26.7 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed A26.7 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.455. The V24 model used during the PY2024–PY2025 transition mapped A26.7 the same way and at the same RAF weight. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Verify that sepsis is documented in the medical record before assigning this code, as it indicates a systemic infection rather than localized erysipeloid. Because A26.7 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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