A41.2 ICD-10-CM Code: Sepsis due to unspecified staphylococcus

Code

A41.2

Description

Sepsis due to unspecified staphylococcus

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 A41.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.2

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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

Commonly Confused Codes

• •A41.01 (MSSA sepsis): Preferred when methicillin-susceptible S. aureus is confirmed
• •A41.02 (MRSA sepsis): Preferred when methicillin-resistant S. aureus is confirmed
• •A41.1 (Other specified staphylococcus): Preferred when a specific non-aureus species is identified
• •A41.9 (Sepsis, unspecified organism): A41.2 is more specific than A41.9 since it identifies the genus

Child Codes