2025 ICD-10-CM code A41.89
(Active) Effective Date: N/A Certain infectious and parasitic diseases - Other bacterial diseases 1 Feed
Other specified sepsis. This code is used when the provider documents a specific type of sepsis that is not represented by other codes.
Medical necessity for the treatment of sepsis is established by the presence of signs and symptoms consistent with a severe systemic infection, along with laboratory and clinical findings supporting the diagnosis.
Providers diagnose other specified sepsis based on the patient’s symptoms, history, and physical findings. Laboratory tests of the patient’s blood, urine, stool, skin specimen, respiratory secretions, and vomit can detect the bacterium. Treatment includes antibiotics and other supportive measures, including oxygen and intravenous fluids. At times, surgery may be indicated to clear up the infection. Providers may educate patients at a high risk, such as the elderly and immunocompromised, on prevention of this condition.
In simple words: Other specified sepsis is a severe infection that causes the body to react in a way that can harm its own tissues and organs. It can be life-threatening.This term is used when the doctor knows the specific type of sepsis, but it doesn't have its own code.
Other specified sepsis refers to a serious medical condition in which the body has a massive immune response to toxins released by bacteria into the bloodstream, which can lead to tissue damage, organ failure, and death.The provider documents a specific type of sepsis not represented by other codes.
Example 1: A patient presents with fever, chills, rapid heart rate, and altered mental status. Blood cultures identify a rare bacterial infection not specifically listed in ICD-10-CM as a cause of sepsis. The provider documents "sepsis due to [rare bacteria]." Code A41.89 is assigned., Following a routine surgical procedure, a patient develops signs and symptoms of sepsis. Cultures reveal a polymicrobial infection, with multiple bacterial species present.No single organism is identified as the primary cause, and no specific sepsis code exists for this combination of organisms. Code A41.89 is assigned., A patient with a known history of intravenous drug use presents with fever, hypotension, and elevated lactate levels.The provider suspects sepsis but blood cultures are negative.The clinical picture strongly suggests sepsis, and the provider documents "sepsis, likely related to intravenous drug use, organism unspecified." Code A41.89 is assigned.
Documentation should include: type of sepsis, causative organism (if known), evidence of systemic inflammatory response syndrome (SIRS), and any associated organ dysfunction.
** Use additional code to identify resistance to antimicrobial drugs (Z16.-). If the type of sepsis is documented and a more specific code exists, use that code instead of A41.89.
- Specialties:Infectious Disease, Critical Care Medicine, Internal Medicine, Family Medicine, Emergency Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office