B37.7
BillableCandidal sepsis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B37.7 an HCC code?
No. B37.7 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 B37.7
For B37.7 to 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 B37.7 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B37.7 is the ICD-10-CM diagnosis code for candidal sepsis. A life-threatening bloodstream infection caused by Candida yeast that spreads throughout the body. B37.7 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering mycoses (b35-b49).
B37.7 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Maps only to RxHCC 5 (Opportunistic Infections) with RAF 0.0. This code does NOT map to any V28 or V24 community HCC, which is a notable gap given that candidemia carries 30-50% mortality. The lack of community HCC mapping means this severe fungal sepsis does not contribute to community model risk scores despite its clinical gravity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B37.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a critical condition requiring blood culture confirmation; verify positive candidal blood cultures in documentation
- •Typically requires ICU-level care and systemic antifungal therapy; ensure severity of illness is reflected in coding
Clinical Significance
Candidal sepsis (candidemia) is a life-threatening bloodstream infection caused by Candida species, most commonly occurring in hospitalized patients with central venous catheters, prolonged antibiotic use, or immunosuppression. It carries 30-50% mortality and requires immediate systemic antifungal therapy and source control (often catheter removal).
Documentation Requirements
- ✓Positive blood culture for Candida species (candidemia confirmed)
- ✓Species identification and antifungal susceptibility testing documented
- ✓Source of candidemia investigated: central line, GI tract, genitourinary source
- ✓SIRS/sepsis criteria met with organ dysfunction assessment
- ✓Treatment: antifungal agent, central line removal if catheter-associated, ophthalmologic exam for Candida endophthalmitis screening
Commonly Confused Codes
- •A41.9 (Sepsis, unspecified organism) — Generic sepsis; use B37.7 when Candida is the confirmed organism from blood cultures
- •B37.1 (Pulmonary candidiasis) — Lung-specific infection; candidemia is bloodstream infection that may or may not involve lungs
- •B37.49 (Other urogenital candidiasis) — Localized Candida infection; sepsis indicates bloodstream spread
- •B49 (Unspecified mycosis) — Nonspecific fungal infection; B37.7 provides organism and site specificity