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ICD-10-CM Code View

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

A42

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Actinomycosis

Actinomycosis

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
A4Other bacterial diseases (A30-A49)
A42Actinomycosis

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for A42 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for A42 in this effective period.

Related Child Codes

Official
A42.0Pulmonary actinomycosis
A42.1Abdominal actinomycosis
A42.2Cervicofacial actinomycosis
A42.7Actinomycotic sepsis
A42.8Other forms of actinomycosis

Includes

Official

ICD-10-CM does not list Includes notes for A42 in this effective period.

Excludes 1

Official
  • actinomycetoma (B47.1)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for A42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for A42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for A42 in this effective period.

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.

What This Code Means

A42 is the ICD-10-CM diagnosis code for actinomycosis. A42 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).

Header codes like A42 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at A42's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1 — Do NOT code together

Child Codes

Code Hierarchy

A42Actinomycosis
A42Actinomycosis

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