A41.02 ICD-10-CM Code: Sepsis due to Methicillin resistant Staphylococcus aureus

Code

A41.02

Description

Sepsis due to Methicillin resistant 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 A41.02 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.02

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Always verify that sepsis is documented in the medical record along with the specific MRSA organism; sepsis requires both the infection and systemic response to be present
• •Code A41.02 should be paired with a code for the source of infection (if documented) and any organ dysfunction codes (such as acute kidney injury or respiratory failure) to capture the full clinical picture

Clinical Significance

Sepsis due to methicillin-resistant Staphylococcus aureus (MRSA) is a serious healthcare-associated bloodstream infection requiring vancomycin or alternative anti-MRSA therapy. MRSA sepsis carries higher mortality than MSSA sepsis, increased length of stay, and greater healthcare costs. It is a critical infection control concern requiring contact precautions.

Documentation Requirements

• ✓Blood cultures positive for Staphylococcus aureus with methicillin resistance confirmed on susceptibility testing
• ✓Documentation explicitly stating MRSA (not just S. aureus without resistance pattern)
• ✓Infection source identified (central line, wound, pneumonia, surgical site)
• ✓Vancomycin trough levels or alternative anti-MRSA antibiotic therapy documentation
• ✓Infection control measures documented (contact precautions, decolonization protocols)

Commonly Confused Codes

• •A41.01 (MSSA sepsis): Critical distinction: MRSA requires vancomycin while MSSA is treated with beta-lactams; susceptibility testing determines the correct code
• •A41.2 (Sepsis due to unspecified staphylococcus): Use A41.02 when MRSA is confirmed; do not default to unspecified
• •Z16.11 (Resistance to penicillins): Z16 codes can be used as additional codes but do not replace A41.02 for MRSA sepsis

Child Codes