A41.2
BillableSepsis due to unspecified staphylococcus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is A41.2 an HCC code?
Yes. A41.2 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 A41.2
For A41.2 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 A41.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
A41.2 is the ICD-10-CM diagnosis code for sepsis due to unspecified staphylococcus. A serious bloodstream infection caused by staphylococcus bacteria when the specific type of staph cannot be identified. This is a life-threatening condition where bacteria have entered the bloodstream and triggered a severe inflammatory response throughout the body. A41.2 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).
Under the CMS-HCC V28 risk adjustment model, A41.2 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 A41.2 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.
Always attempt to obtain the specific staphylococcus organism type (aureus, epidermidis, etc.) from culture results or clinical documentation, as more specific codes (A41.0, A41.1) are preferred over the unspecified code A41.2. Because A41.2 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 A41.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always attempt to obtain the specific staphylococcus organism type (aureus, epidermidis, etc.) from culture results or clinical documentation, as more specific codes (A41.0, A41.1) are preferred over the unspecified code A41.2
- •Sepsis codes require a secondary code to identify the source of infection when documented; review the medical record for any localized infection site that may have seeded the bloodstream
Clinical Significance
Sepsis due to unspecified staphylococcus is used when staphylococcal bloodstream infection is documented but the specific species (aureus vs. coagulase-negative) or methicillin susceptibility is not identified. This code should be a placeholder pending culture and susceptibility results rather than a final code assignment.
Documentation Requirements
- ✓Blood cultures growing Staphylococcus species without further speciation or susceptibility testing completed
- ✓Clinical sepsis criteria met
- ✓Documentation that staphylococcal species identification is pending or unavailable
- ✓Query provider for species-level identification when results become available
- ✓Clinical context suggesting staphylococcal source