A40.0

HCC Category Mapping

What This Code Means

A serious bloodstream infection caused by Group A Streptococcus bacteria that can spread throughout the body and cause organ failure. This is a life-threatening condition requiring immediate medical treatment.

Coding Tips

• •Always verify the organism identification (Group A Streptococcus) is documented in the medical record before assigning this code
• •Remember that sepsis codes require a secondary code for the associated organ dysfunction (SIRS criteria) and may require additional codes for the source of infection if documented

Clinical Significance

Sepsis due to Group A Streptococcus (Streptococcus pyogenes) is an aggressive, rapidly progressive bloodstream infection associated with necrotizing fasciitis, streptococcal toxic shock syndrome, and high mortality. Group A Streptococcal sepsis requires urgent source control, high-dose penicillin, and often clindamycin for toxin suppression.

Documentation Requirements

• ✓Blood cultures positive for Group A Streptococcus (S. pyogenes) or clinical sepsis with identified GAS source
• ✓Sepsis criteria met: documented infection with systemic inflammatory response
• ✓Source of infection identified (pharyngitis, cellulitis, necrotizing fasciitis, puerperal infection)
• ✓Severity indicators: organ dysfunction, hemodynamic status, vasopressor requirements
• ✓Complications documented: necrotizing fasciitis, streptococcal toxic shock syndrome, if present

Commonly Confused Codes