Is ICD-10-CM code A40 billable?

No, A40 (Streptococcal sepsis) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code A40 belong to?

A40 belongs to Chapter 1 of the ICD-10-CM tabular list: A00–B99 (Certain Infectious and Parasitic Diseases).

A40Not billable, use a more specific code below

Streptococcal sepsis

In Other bacterial diseases (A30-A49), chapter 1: Certain Infectious and Parasitic Diseases

5 billable codes under A40: all are an MCC; all map to HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

neonatal (P36.0-P36.1)
puerperal sepsis (O85)
sepsis due to Streptococcus, group D (A41.81)

Code first: code the underlying condition first, then this code

if applicable, postprocedural sepsis (T81.44-)
sepsis due to central venous catheter (T80.211-)
streptococcal sepsis during labor (O75.3)
streptococcal sepsis following abortion or ectopic or molar pregnancy (O03.37, O03.87, O04.87, O07.37, O08.82)
streptococcal sepsis following immunization (T88.0-)
streptococcal sepsis following infusion, transfusion or therapeutic injection (T80.22-, T80.29-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Section I.C.1.d Sepsis, Severe Sepsis, and Septic Shock (page 23), covers A40
Code the underlying systemic infection first (A41.9 if unspecified), then a code from R65.2 only when severe sepsis or related acute organ dysfunction is documented, plus organ dysfunction codes. R65.2 codes can never be principal diagnosis.

All codes under A40

A40 can't be used on a claim. Pick a billable code below; grey headings group them.

A40 MS-DRGs

As the principal diagnosis, the billable codes under A40 group to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 870 Septicemia or Severe Sepsis with MV >96 Hours (5 of 5 codes)
DRG 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC (5 of 5 codes)
DRG 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC (5 of 5 codes)
DRG 791 Prematurity with Major Problems (1 of 5 codes)
DRG 793 Full Term Neonate with Major Problems (1 of 5 codes)
DRG 974 HIV with Major Related Condition with MCC (1 of 5 codes)
DRG 975 HIV with Major Related Condition with CC (1 of 5 codes)
DRG 976 HIV with Major Related Condition without CC/MCC (1 of 5 codes)

Other codes that refer to A40

Notes on these codes point to A40.

A41 Excludes1: streptococcal sepsis (A40.-)
J95.02 Use Additional Code: sepsis (A40, A41.-)
K94.02 Use Additional Code: sepsis (A40.-, A41.-)
K94.12 Use Additional Code: sepsis (A40.-, A41.-)
K94.22 Use Additional Code: sepsis (A40.-, A41.-)
K95.01 Use Additional Code: sepsis (A40.-, A41.-)
K95.81 Use Additional Code: sepsis (A40.-, A41.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Sepsis

Sepsis is your body's overactive and extreme response to an infection. Sepsis is a life-threatening medical emergency. Without quick treatment, it can lead to tissue damage, organ failure, and even death.

Streptococcal Infections

Strep is short for Streptococcus, a type of bacteria that often lives in your nose and throat. Most strep infections are mild, but some may become serious depending on your overall health.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.