A54.83 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupA54.83

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)

A54.83

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

Gonococcal heart infection

A bacterial infection of the heart caused by gonorrhea (a sexually transmitted infection), where the bacteria spreads from the genital area to infect the heart tissue. This is a serious complication that can damage heart valves and affect heart function.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 135

HHS-HCC 135 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

A54Gonococcal infection A54.8Other gonococcal infections A54.83Gonococcal heart infection

Inclusion Terms

Official

Gonococcal endocarditis
Gonococcal myocarditis
Gonococcal pericarditis

Excludes 2

Official

carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99, A50-A64
infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99, A50-A64
infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99, A50-A64
influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99, A50-A64
human immunodeficiency virus [HIV] disease (B20)Inherited from A00-B99, A50-A64

Related Codes

Official

A54.81Gonococcal meningitis A54.82Gonococcal brain abscess A54.84Gonococcal pneumonia A54.85Gonococcal peritonitis A54.86Gonococcal sepsis

Includes

Official

diseases generally recognized as communicable or transmissibleInherited from A00-B99

Excludes 1

Official

certain localized infections - see body system-related chaptersInherited from A00-B99, A50-A64
nonspecific and nongonococcal urethritis (N34.1)Inherited from A00-B99, A50-A64
Reiter's disease (M02.3-)Inherited from A00-B99, A50-A64

Code First

Official

No Code First sequencing instructions are included in this display for A54.83. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99

Code Also

Official

No Code Also instructions are included in this display for A54.83. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify documentation confirms gonococcal infection of the heart specifically; do not assume heart involvement without explicit physician documentation

This code requires confirmation of both the gonococcal organism AND cardiac involvement; ensure the medical record supports endocarditis or myocarditis related to gonorrhea

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 A54.83 an HCC code?

Code: A54.83
Description: Gonococcal heart infection
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

A54.83 is the ICD-10-CM diagnosis code for gonococcal heart infection. A bacterial infection of the heart caused by gonorrhea (a sexually transmitted infection), where the bacteria spreads from the genital area to infect the heart tissue. This is a serious complication that can damage heart valves and affect heart function. A54.83 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).

A54.83 has no mapping under the current CMS-HCC V28 community payment model. A54.83 also appears in the HHS-HCC commercial risk model (HCC 135 (HHS-HCC 135 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

Verify documentation confirms gonococcal infection of the heart specifically; do not assume heart involvement without explicit physician documentation.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A54.83 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation confirms gonococcal infection of the heart specifically; do not assume heart involvement without explicit physician documentation
•This code requires confirmation of both the gonococcal organism AND cardiac involvement; ensure the medical record supports endocarditis or myocarditis related to gonorrhea