2025 ICD-10-CM code B95.1
This code identifies Streptococcus group B bacteria as the cause of a disease classified elsewhere.
Medical necessity is established by the presence of a clinically significant infection caused by Streptococcus group B, confirmed by laboratory testing.Treatment for GBS infections is medically necessary to prevent serious complications, which can include sepsis, meningitis, and pneumonia, especially in newborns and immunocompromised individuals.
The provider's responsibility is to diagnose the specific condition caused by the Streptococcus group B bacteria and to accurately document the diagnosis with both the disease code and the B95.1 code as a secondary code. Treatment will vary depending on the site and severity of the infection.
In simple words: This code identifies a bacterial infection caused by Streptococcus group B. This bacteria commonly lives in the digestive system and can cause serious infections, particularly in newborns.This code must be used with another code that describes the specific disease caused by the bacteria.
Streptococcus group B (GBS) bacteria as the cause of a disease classified elsewhere. Use this code in conjunction with other code(s) identifying the disease(s) or condition(s). This code should not be used as the first-listed or principal diagnosis but should follow the disease or condition code(s).
Example 1: A newborn infant develops sepsis shortly after birth. Blood cultures identify Streptococcus group B as the cause. The appropriate codes would be for the sepsis (e.g., P36.0) followed by B95.1., A pregnant woman is found to be colonized with Streptococcus group B during a routine screening. Since she is not currently ill, the appropriate code would be Z22.3 (Carrier or suspected carrier of Streptococcus, group B). Code B95.1 would not be appropriate in this case since it’s for use when GBS causes a disease., An elderly patient with a urinary tract infection (UTI) is found to have Streptococcus group B as the causative organism. The appropriate codes would be for the UTI (e.g., N39.0) followed by B95.1.
Documentation should include positive culture results identifying Streptococcus agalactiae (group B) as the causative organism of the infection.The specific manifestation of the infection should also be clearly documented (e.g., sepsis, pneumonia, UTI).
- Specialties:Infectious Disease, Pediatrics, Obstetrics and Gynecology, Internal Medicine, Family Medicine, Neonatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Home, Skilled Nursing Facility