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A41.81 ICD-10-CM Code: Sepsis due to Enterococcus

A41.81 maps to CMS-HCC V28 2 (RAF 0.500). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Other bacterial diseases (A30-A49)

A41.81

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sepsis due to Enterococcus

This is a serious bloodstream infection caused by Enterococcus bacteria, a type of germ commonly found in the digestive system that has spread into the blood. This condition requires immediate medical treatment with antibiotics.

Buddy the Bee presenting code insight

Buddy Insight

Sepsis due to Enterococcus is a bloodstream infection caused by Enterococcus faecalis or E.

CMS-HCC V28

HCC 2

RAF 0.500

CMS-HCC V24

HCC 2

RAF 0.352

ACA/HHS

HCC 2

Varies by metal level

ESRD/PACE

HCC 2

RAF 0.087

RXHCC

N/A

—

Not mapped

Code Book Path

Official
A41Other sepsis
A41.8Other specified sepsis
A41.81Sepsis due to Enterococcus

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for A41.81 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for A41.81 in this effective period.

Related Child Codes

Official
A41.89Other specified sepsis

Includes

Official

ICD-10-CM does not list Includes notes for A41.81 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for A41.81 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for A41.81 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for A41.81 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for A41.81 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Blood cultures positive for Enterococcus species (specify faecalis vs. faecium when available)
Source of Enterococcal infection (urinary tract, biliary, intra-abdominal, endocarditis)
Vancomycin susceptibility status — VRE vs. VSE is critical for treatment and infection control
Sepsis criteria and organ dysfunction documentation

MEAT Support

HCC Buddy guidance
Blood cultures positive for Enterococcus species (specify faecalis vs. faecium when available)
Source of Enterococcal infection (urinary tract, biliary, intra-abdominal, endocarditis)
Vancomycin susceptibility status — VRE vs. VSE is critical for treatment and infection control
Sepsis criteria and organ dysfunction documentation

Audit Caution

HCC Buddy guidance
If vancomycin-resistant Enterococcus (VRE) is documented, add Z16.21 (Resistance to vancomycin) as an additional code
E. faecium is more commonly vancomycin-resistant than E. faecalis — species-level documentation affects treatment decisions
Enterococcal endocarditis is a well-known complication — evaluate for and code I33.0 when documented
Do not confuse Enterococcus (a gram-positive coccus) with Enterobacter (a gram-negative bacillus)

Common Mistakes

HCC Buddy guidance
A41.1 (Sepsis due to other specified staphylococcus) — Enterococcus is not a staphylococcus; ensure correct genus identification
A41.89 (Other specified sepsis) — A41.81 is the specific code for Enterococcus; do not use the 'other' category
A41.9 (Sepsis, unspecified) — Use A41.81 when Enterococcus is identified

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is A41.81 an HCC code?

Yes. A41.81 (Sepsis due to Enterococcus) 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), with a community non-dual aged RAF of 0.500. It is billable for payment year 2026.

Coder answer: A41.81 is billable and maps to V28 HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
A41.81
Description
Sepsis due to Enterococcus
HCC (V28)
HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
RAF
0.500
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
0.500
V24HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
0.352
ESRDHCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
0.087

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work A41.81 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for A41.81

For A41.81 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 A41.81 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

A41.81 is the ICD-10-CM diagnosis code for sepsis due to enterococcus. This is a serious bloodstream infection caused by Enterococcus bacteria, a type of germ commonly found in the digestive system that has spread into the blood. This condition requires immediate medical treatment with antibiotics. A41.81 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, A41.81 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a community, non-dual, aged base RAF weight of 0.500. Under the older V24 model, A41.81 mapped to the same category but with a base RAF weight of 0.352, V28 recalibrated weights across the entire model. 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.

Ensure the documentation clearly states 'sepsis' and 'Enterococcus' to support this specific code; do not use if only a urinary tract infection or localized infection is present. Because A41.81 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 A41.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Ensure the documentation clearly states 'sepsis' and 'Enterococcus' to support this specific code; do not use if only a urinary tract infection or localized infection is present
  • •Code A41.81 should be paired with a code for the source of infection (such as R65.20 for sepsis without acute organ dysfunction) and any associated organ dysfunction codes if applicable

Clinical Significance

Sepsis due to Enterococcus is a bloodstream infection caused by Enterococcus faecalis or E. faecium, commonly arising from urinary tract, intra-abdominal, or biliary sources. Enterococcal sepsis is of particular concern due to the emergence of vancomycin-resistant Enterococcus (VRE), which severely limits treatment options. It is frequently healthcare-associated.

Documentation Requirements

  • ✓Blood cultures positive for Enterococcus species (specify faecalis vs. faecium when available)
  • ✓Source of Enterococcal infection (urinary tract, biliary, intra-abdominal, endocarditis)
  • ✓Vancomycin susceptibility status — VRE vs. VSE is critical for treatment and infection control
  • ✓Sepsis criteria and organ dysfunction documentation
  • ✓Healthcare-associated vs. community-acquired infection assessment

Commonly Confused Codes

  • •A41.1 (Sepsis due to other specified staphylococcus): Enterococcus is not a staphylococcus; ensure correct genus identification
  • •A41.89 (Other specified sepsis): A41.81 is the specific code for Enterococcus; do not use the 'other' category
  • •A41.9 (Sepsis, unspecified): Use A41.81 when Enterococcus is identified

Child Codes

A41.81Sepsis due to Enterococcus
HCC 2
A41.89Other specified sepsis
HCC 2

Code Hierarchy

└A41Other sepsis└A41.8Other specified sepsis└A41.81Sepsis due to Enterococcus
└A41.81Sepsis due to Enterococcus

Because A41.81 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

A41.81 maps to CMS-HCC V28 category 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because A41.81 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

Work A41.81 in HCC Buddy

Open A41.81 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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