A40.1

HCC Category Mapping

What This Code Means

This is a serious bloodstream infection caused by Group B Streptococcus bacteria, which can spread throughout the body and cause life-threatening complications. Group B Strep is commonly found in the digestive and reproductive tracts and can be particularly dangerous in newborns, pregnant women, and elderly patients.

Coding Tips

• •Always verify the documentation specifies Group B Streptococcus (not other streptococcal groups) and confirms sepsis diagnosis before assigning this code
• •This code requires a secondary code for the site of infection or organ dysfunction (such as septic shock R65.21, acute kidney injury, or respiratory failure) to fully capture the clinical picture and severity

Clinical Significance

Sepsis due to Group B Streptococcus (Streptococcus agalactiae) predominantly affects neonates (early and late-onset neonatal sepsis), pregnant/postpartum women, and elderly or immunocompromised adults. In neonates, it remains a leading cause of sepsis and meningitis despite universal prenatal screening, and in adults it is increasingly recognized as a cause of serious invasive disease.

Documentation Requirements

• ✓Blood cultures positive for Group B Streptococcus or clinical sepsis with GBS identified from relevant source
• ✓Patient demographics and risk context (neonate, peripartum, elderly, diabetic, immunocompromised)
• ✓In neonates: timing of onset (early <7 days vs. late 7-90 days), maternal GBS colonization status, intrapartum antibiotic prophylaxis received or not
• ✓Sepsis severity assessment with organ dysfunction documentation
• ✓Source of infection if identified (urinary tract, skin/soft tissue, endometritis, osteoarticular)

Commonly Confused Codes