A40.3 Sepsis due to Streptococcus pneumoniae

Billable ICD-10-CM code, FY2026. Acts as a Major Complication or Comorbidity (MCC) as a secondary diagnosis.

Applicable to

• Pneumococcal sepsis

Applies from A40 Streptococcal sepsis

Excludes1 (never code together)

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

Code first

• , 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-)

Risk adjustment (HCC)

• CMS-HCC V28: HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
• CMS-HCC V22: HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
• ESRD V24: HCC 2

MS-DRG index

Defines the logic of DRG(s) 870-872 in MDC 18.

Approximate ICD-9-CM (GEMs)

• 038.0 Streptococcal septicemia (approximate)
• 038.2 Pneumococcal septicemia [Streptococcus pneumoniae septicemia] (approximate)
• 995.91 Sepsis (approximate)

Code annotations containing back-references to A40.3

Back-references to A40.3

• Use Additional: D59.31 Infection-associated hemolytic-uremic syndrome ("Sepsis due to Streptococcus pneumoniae (A40.3)")
• Code First: N08 Glomerular disorders in diseases classified elsewhere ("sepsis (A40.0-A41.9)")
• Code First: N16 Renal tubulo-interstitial disorders in diseases classified elsewhere ("sepsis (A40.0-A41.9)")

Back-references to A40

• Type 1 Excludes: A41 Other sepsis ("streptococcal sepsis (A40.-)")
• Use Additional: J95.02 Infection of tracheostomy stoma ("sepsis (A40, A41.-)")
• Use Additional: K94.02 Colostomy infection ("sepsis (A40.-, A41.-)")
• Use Additional: K94.12 Enterostomy infection ("sepsis (A40.-, A41.-)")
• Use Additional: K94.22 Gastrostomy infection ("sepsis (A40.-, A41.-)")
• Use Additional: K95.01 Infection due to gastric band procedure ("sepsis (A40.-, A41.-)")
• Use Additional: K95.81 Infection due to other bariatric procedure ("sepsis (A40.-, A41.-)")

Diagnosis Index entries for A40.3

• Embolism (multiple) (paradoxical) › pyemic (multiple) › pneumococcal
• Infection, infected, infective (opportunistic) › pneumococcus, pneumococcal NEC › generalized (purulent)
• Pneumococcemia
• Pyemia, pyemic (fever) (infection) (purulent) › pneumococcal
• Sepsis (generalized) (unspecified organism) › pneumococcal
• Sepsis (generalized) (unspecified organism) › Streptococcus, streptococcal › pneumoniae

Nearby codes

• A40 Streptococcal sepsis
• A40.0 Sepsis due to streptococcus, group A
• A40.1 Sepsis due to streptococcus, group B
• A40.3 Sepsis due to Streptococcus pneumoniae (this code)
• A40.8 Other streptococcal sepsis
• A40.9 Streptococcal sepsis, unspecified