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FY2027 ICD-10-CM reference

P36.10: Sepsis of newborn due to unspecified streptococci

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Sepsis of newborn due to unspecified streptococci. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

CMS-HCC V28

  • HCC 2: Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock · RAF 0.500, Community Non-Dual Aged (CNA)

Payment year 2027, 2026 dates of service. HCC from the CMS 2027 Initial ICD-10-CM Mappings; RAF from the CMS-HCC V28 relative factors. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings.

CMS-HCC V24

Not used for payment year 2027 Medicare Advantage payment

ESRD

  • HCC 2: Septicemia/Sepsis/Systemic Inflammatory Response Syndrome/Shock

Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.

PACE

Source verification pending

RxHCC

No category in the PY2026 CMS mapping; CMS 2027 initial file unchanged

HHS-HCC

  • HCC 2: Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock

RAF not applicable: HHS-HCC weights vary by metal level. Mapping: HHS-HCC 2026 benefit year.

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Instructional note

Codes from this chapter are for use on newborn records only, never on maternal records

Source: P00-P96 (chapter, inherited).

Includes

conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later

Source: P00-P96 (chapter, inherited).

Excludes2

congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Source: P00-P96 (chapter, inherited).

Excludes2

endocrine, nutritional and metabolic diseases (E00-E88)

Source: P00-P96 (chapter, inherited).

Excludes2

injury, poisoning and certain other consequences of external causes (S00-T88)

Source: P00-P96 (chapter, inherited).

Excludes2

neoplasms (C00-D49)

Source: P00-P96 (chapter, inherited).

Excludes2

tetanus neonatorum (A33)

Source: P00-P96 (chapter, inherited).

Instructional note

Infections acquired in utero, during birth via the umbilicus, or during the first 28 days after birth

Source: P35-P39 (section, inherited).

Excludes2

asymptomatic human immunodeficiency virus [HIV] infection status (Z21)

Source: P35-P39 (section, inherited).

Excludes2

congenital gonococcal infection (A54.-)

Source: P35-P39 (section, inherited).

Excludes2

congenital pneumonia (P23.-)

Source: P35-P39 (section, inherited).

Excludes2

congenital syphilis (A50.-)

Source: P35-P39 (section, inherited).

Excludes2

human immunodeficiency virus [HIV] disease (B20)

Source: P35-P39 (section, inherited).

Excludes2

infant botulism (A48.51)

Source: P35-P39 (section, inherited).

Excludes2

infectious diseases not specific to the perinatal period (A00-B99, J09, J10.-)

Source: P35-P39 (section, inherited).

Excludes2

intestinal infectious disease (A00-A09)

Source: P35-P39 (section, inherited).

Excludes2

laboratory evidence of human immunodeficiency virus [HIV] (R75)

Source: P35-P39 (section, inherited).

Excludes2

tetanus neonatorum (A33)

Source: P35-P39 (section, inherited).

Includes

congenital sepsis

Source: P36 (category, inherited).

Instructional note

code(s), if applicable, to identify severe sepsis (R65.2-) and associated acute organ dysfunction(s)

Source: P36 (category, inherited).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does P36.10 mean in FY2027?

The official ICD-10-CM descriptor is Sepsis of newborn due to unspecified streptococci. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is P36.10 billable in FY2027?

The FY2027 order file marks P36.10 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does P36.10 map to an HCC?

In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), P36.10 maps to CMS-HCC V28 HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 2; no RxHCC category. Coefficients for these models are pending verification for payment year 2027. HHS-HCC: HCC 2 under the HHS-HCC 2026 benefit year mapping (no RAF; HHS-HCC weights vary by metal level). CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). The PACE mapping is still pending verification for FY2027.

Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.

Review the FY2026 April edition