A41.52 ICD-10-CM Code: Sepsis due to Pseudomonas

Code

A41.52

Description

Sepsis due to Pseudomonas

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 A41.52 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.52

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.52 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 before coding A41.52; sepsis requires a systemic inflammatory response to the infection
• •Code the underlying source of infection if documented (e.g., respiratory tract, urinary tract, wound) as an additional diagnosis code for complete clinical picture

Clinical Significance

Sepsis due to Pseudomonas is a high-mortality bloodstream infection predominantly affecting immunocompromised, hospitalized, and critically ill patients. Pseudomonas aeruginosa is intrinsically resistant to many antibiotics and requires specific anti-pseudomonal coverage (piperacillin-tazobactam, cefepime, meropenem, or combination therapy). It is a leading cause of ventilator-associated pneumonia and catheter-related bloodstream infections.

Documentation Requirements

• ✓Blood cultures positive for Pseudomonas species (typically P. aeruginosa)
• ✓Source of Pseudomonas infection (ventilator-associated pneumonia, central line, urinary catheter, burn wound, neutropenic fever)
• ✓Antibiotic susceptibility results — document multidrug resistance if present
• ✓ICU admission status and severity of illness
• ✓Underlying conditions predisposing to Pseudomonas infection (neutropenia, burns, cystic fibrosis, mechanical ventilation)

Commonly Confused Codes

• •A41.50 (Gram-negative sepsis, unspecified): Use A41.52 when Pseudomonas is specifically identified
• •A41.59 (Other gram-negative sepsis): A41.52 has its own specific code; do not use the 'other' category
• •J15.1 (Pneumonia due to Pseudomonas): Code J15.1 separately when pneumonia is the source of Pseudomonas sepsis

Child Codes