A41.89 ICD-10-CM Code: Other specified sepsis

Code

A41.89

Description

Other specified sepsis

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 A41.89 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for A41.89

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A41.89 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 causative organism is documented but doesn't fit into more specific A41 subcategories (such as Staphylococcus, Streptococcus, or E. coli sepsis)
• •Always query the provider if the causative organism is not documented, as more specific codes may be available and could affect treatment protocols and reporting

Clinical Significance

Other specified sepsis is a catch-all code for bloodstream infections caused by organisms that do not have their own specific ICD-10 sepsis code, including fungal sepsis (Candida, Aspergillus), viral sepsis, or rare bacterial pathogens. This code requires careful documentation to identify the causative organism even though the ICD-10 system groups them under 'other.'

Documentation Requirements

• ✓Blood cultures or clinical evidence identifying the specific causative organism
• ✓Documentation of the organism name even though ICD-10 groups it as 'other specified'
• ✓Sepsis criteria met with systemic inflammatory response and organ dysfunction
• ✓Source of infection identified and documented
• ✓Appropriate antimicrobial therapy documented (antifungal for Candida, antiviral for viral sepsis)

Commonly Confused Codes

• •A41.9 (Sepsis, unspecified organism): A41.89 indicates a known organism that lacks its own code; A41.9 is when no organism is identified at all
• •B37.7 (Candidal sepsis): Candidal sepsis has its own code B37.7 and should NOT be coded as A41.89
• •A40/A41.0-A41.59: Check all organism-specific sepsis codes before defaulting to A41.89

Child Codes