A41.01 ICD-10-CM Code: Sepsis due to Methicillin susceptible Staphylococcus aureus

Code

A41.01

Description

Sepsis due to Methicillin susceptible Staphylococcus aureus

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 A41.01 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.01

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Ensure documentation specifies that the S. aureus is methicillin-susceptible (not resistant) to assign this code correctly, as methicillin-resistant strains use different codes (A41.02)
• •This code requires a secondary code to identify the source/site of infection (e.g., skin, urinary tract, wound) when documented, and may require additional codes for organ dysfunction if septic shock is present

Clinical Significance

Sepsis due to methicillin-susceptible Staphylococcus aureus (MSSA) is a common and serious bloodstream infection with significant morbidity and mortality. MSSA sepsis carries a risk of metastatic complications including endocarditis, osteomyelitis, and deep-seated abscesses. The methicillin susceptibility designation is clinically important as it determines antibiotic therapy (nafcillin/oxacillin preferred over vancomycin).

Documentation Requirements

• ✓Blood cultures positive for Staphylococcus aureus with susceptibility testing showing methicillin susceptibility
• ✓Documentation explicitly stating MSSA (not just S. aureus without susceptibility information)
• ✓Sepsis criteria met with identified source when possible
• ✓Echocardiogram results to evaluate for endocarditis (recommended for all S. aureus bacteremia)
• ✓Follow-up blood cultures to document clearance (standard of care for S. aureus bacteremia)

Commonly Confused Codes

• •A41.02 (MRSA sepsis): MRSA is methicillin-resistant; the distinction determines antibiotic therapy and carries epidemiologic significance
• •A41.2 (Sepsis due to unspecified staphylococcus): Use A41.01 when MSSA is specifically identified, not the unspecified staph code
• •A41.1 (Sepsis due to other specified staphylococcus): A41.1 is for coagulase-negative staph species; A41.01 is for S. aureus specifically

Child Codes