A41.3 ICD-10-CM Code: Sepsis due to Hemophilus influenzae

Code

A41.3

Description

Sepsis due to Hemophilus influenzae

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 A41.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.3

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Ensure documentation clearly states 'sepsis' and identifies Hemophilus influenzae as the causative organism before assigning this code
• •This code should be paired with a code for the systemic inflammatory response (SIRS) or organ dysfunction codes to fully capture the severity of sepsis

Clinical Significance

Sepsis due to Haemophilus influenzae is a serious bloodstream infection that predominantly occurs in unvaccinated children, the elderly, and immunocompromised adults. Since the introduction of the Hib vaccine, invasive H. influenzae disease has shifted toward non-typeable and non-type b strains, particularly in adults with chronic lung disease or immunodeficiency.

Documentation Requirements

• ✓Blood cultures positive for Haemophilus influenzae
• ✓Sepsis criteria documented with hemodynamic assessment
• ✓Age-specific context: vaccination status in children, comorbidities in adults
• ✓Source of infection (respiratory tract, meningitis, epiglottitis, cellulitis)
• ✓H. influenzae type (typeable serotypes a-f or non-typeable) if available

Commonly Confused Codes

• •J14 (Pneumonia due to Haemophilus influenzae): J14 is pneumonia only; A41.3 is sepsis: code both when H. influenzae pneumonia progresses to sepsis
• •A41.9 (Sepsis, unspecified organism): Use A41.3 when H. influenzae is identified as the causative organism
• •G00.0 (Hemophilus meningitis): Code G00.0 separately when meningitis accompanies H. influenzae sepsis

Child Codes