A41.89 ICD-10-CM Code: Other specified sepsis
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Other bacterial diseases (A30-A49)
A41.89
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified sepsis
This code represents a serious bloodstream infection (sepsis) caused by organisms not specifically identified by other sepsis codes. It indicates the patient has a systemic infection with bacteria or other pathogens that don't fit into more specific sepsis categories.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 2
RAF 0.455
CMS-HCC V24
MappedHCC 2
RAF 0.455
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 2
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for A41.89 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A41.89 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A41.89 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A41.89 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A41.89 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A41.89 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A41.89 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is A41.89 an HCC code?
Yes. A41.89 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).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for A41.89
For A41.89to 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 A41.89 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
A41.89 is the ICD-10-CM diagnosis code for other specified sepsis. This code represents a serious bloodstream infection (sepsis) caused by organisms not specifically identified by other sepsis codes. It indicates the patient has a systemic infection with bacteria or other pathogens that don't fit into more specific sepsis categories. A41.89 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, A41.89 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a community, non-dual, aged base RAF weight of 0.455. The V24 model used during the PY2024–PY2025 transition mapped A41.89 the same way and at the same RAF weight. 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.
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). Because A41.89 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 A41.89 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