A42.7

HCC Category Mapping

What This Code Means

A serious bloodstream infection caused by Actinomyces bacteria, a type of organism that normally lives in the mouth and can cause severe infection if it spreads throughout the body. This is a life-threatening condition requiring immediate medical treatment with antibiotics.

Coding Tips

• •Verify that sepsis is documented in the medical record along with the actinomycotic infection; sepsis requires specific documentation to support this code
• •Check for any associated conditions or complications (such as abscesses, endocarditis, or organ involvement) that may require additional codes

Clinical Significance

Actinomycotic sepsis is a rare but severe bloodstream infection caused by Actinomyces species, indicating advanced disseminated disease. Actinomyces species are fastidious anaerobes that may be missed on routine blood cultures if anaerobic cultures are not held for sufficient time (typically requires 14+ days of incubation).

Documentation Requirements

• ✓Blood cultures positive for Actinomyces species (note: requires prolonged incubation of anaerobic bottles)
• ✓Clinical documentation of sepsis with systemic inflammatory response
• ✓Source of dissemination identified (cervicofacial, thoracic, abdominopelvic, or IUD-associated pelvic actinomycosis)
• ✓Organ dysfunction and severity assessment
• ✓Prolonged antibiotic treatment plan (IV penicillin transitioning to oral, 6-12 months total)

Commonly Confused Codes