P36.5 ICD-10-CM Code: Sepsis of newborn due to anaerobes
P36.5 maps to CMS-HCC V28 2. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Infections specific to the perinatal period (P35-P39)
P36.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSepsis of newborn due to anaerobes
A serious blood infection in a newborn caused by anaerobic bacteria (bacteria that grow without oxygen).
Buddy Insight
Anaerobic sepsis in newborns is a serious infection caused by bacteria that grow without oxygen, often associated with maternal chorioamnionitis, prolonged rupture of membranes, or gastrointestinal sources.
CMS-HCC V28
MappedHCC 2
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 002
Code-level coefficient reference
ESRD/PACE
MappedHCC 2
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for P36.5 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for P36.5 in this effective period.
Related Child Codes
Includes
Official- congenital sepsis
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for P36.5 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for P36.5 in this effective period.
Use Additional
Official- code(s), if applicable, to identify severe sepsis (R65.2-) and associated acute organ dysfunction(s)
Code Also
OfficialICD-10-CM does not list Code Also instructions for P36.5 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 P36.5 an HCC code?
Yes. P36.5 (Sepsis of newborn due to anaerobes) maps to HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.500. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: P36.5 is billable and maps to V28 HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- P36.5
- Description
- Sepsis of newborn due to anaerobes
- HCC (V28)
- HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
- RAF reference coefficient
- 0.500
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work P36.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for P36.5
For P36.5 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 P36.5 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
P36.5 is the ICD-10-CM diagnosis code for sepsis of newborn due to anaerobes. A serious blood infection in a newborn caused by anaerobic bacteria (bacteria that grow without oxygen). P36.5 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering infections specific to the perinatal period (p35-p39).
Under the CMS-HCC V28 risk adjustment model, P36.5 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a source-labeled community, non-dual, aged reference coefficient of 0.500. No V24 mapping is shown for P36.5; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Anaerobic sepsis in newborns is less common; ensure anaerobic culture results are documented and reviewed. Because P36.5 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for P36.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Anaerobic sepsis in newborns is less common; ensure anaerobic culture results are documented and reviewed
- •Identify the specific anaerobic organism if possible for more precise coding
Clinical Significance
Anaerobic sepsis in newborns is a serious infection caused by bacteria that grow without oxygen, often associated with maternal chorioamnionitis, prolonged rupture of membranes, or gastrointestinal sources. These infections can be particularly challenging to diagnose and treat due to special culture requirements and potential for mixed bacterial infections.
Documentation Requirements
- ✓Positive anaerobic culture results
- ✓Clinical signs of sepsis syndrome
- ✓Associated maternal risk factors
- ✓Anaerobic culture techniques utilized
- ✓Antibiotic coverage for anaerobic organisms
- ✓Gestational age and birth weight
- ✓Source of infection if identified
- ✓Treatment response and duration