A41.50 ICD-10-CM Code: Gram-negative sepsis, unspecified

Code

A41.50

Description

Gram-negative sepsis, unspecified

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 A41.50 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.50

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.50 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use this code only when the gram-negative organism is not specified; if the specific organism is identified (such as E. coli, Pseudomonas, or Klebsiella), use the more specific subcategory codes A41.51-A41.59
• •Sepsis codes require documentation of the systemic inflammatory response; ensure the clinical record clearly documents sepsis diagnosis and consider querying the provider if only bacteremia or infection is documented without sepsis criteria

Clinical Significance

Gram-negative sepsis, unspecified, captures bloodstream infection by an unidentified gram-negative organism. Gram-negative sepsis is associated with higher rates of septic shock due to endotoxin (lipopolysaccharide) release. This unspecified code should be updated when culture identification is available.

Documentation Requirements

• ✓Gram stain of blood cultures showing gram-negative organisms, or clinical documentation of gram-negative sepsis
• ✓Sepsis criteria documented with organ dysfunction assessment
• ✓Pending culture identification noted in documentation
• ✓Source of suspected gram-negative infection (urinary tract, intra-abdominal, respiratory, biliary)
• ✓Empiric antibiotic coverage for gram-negative organisms documented

Commonly Confused Codes

• •A41.51 (Sepsis due to E. coli): Preferred when E. coli is specifically identified
• •A41.52 (Sepsis due to Pseudomonas): Preferred when Pseudomonas is identified
• •A41.59 (Other gram-negative sepsis): Use when a specific gram-negative organism is identified but does not have its own code
• •A41.9 (Sepsis, unspecified organism): A41.50 is more specific than A41.9 since it at least identifies gram-negative morphology

Child Codes