2026 ICD-10-CM Diagnosis Code A54.43Gonococcal osteomyelitis
ICD-10-CM Codes›A00–B99›A50-A64›A54
- Billable — Valid for Submission
- Risk Adjusts — HCC 92
- Not Chronic
A54.43 is a billable ICD-10-CM diagnosis code for gonococcal osteomyelitis. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 456 through 458, 548 through 550. Coders also document this condition as bacterial osteomyelitis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteomyelitis and Sexually transmitted infections (excluding HIV and hepatitis).
For Medicare Advantage risk adjustment, A54.43 maps to CMS-HCC Category 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis) under the V28 model, adding a risk factor of about 0.479 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
A54.43 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bacterial osteomyelitis
- Gonococcal osteomyelitis
- Infection of musculoskeletal system caused by Neisseria gonorrhoeae
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 2 Excludes
- gonococcal infection of spine A54.41
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Gonococcus, gonococcal (disease) (infection) See Also: condition; A54.9
osteomyelitis A54.43
Periostitis (albuminosa) (circumscribed) (diffuse) (infective) (monomelic) See Also: Osteomyelitis;
gonorrheal A54.43
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Gonorrhea
Gonorrhea is a sexually transmitted infection (STI). It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert A54.43 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About A54.43Overview
What is the ICD-10 code for gonococcal osteomyelitis?
The ICD-10-CM code for gonococcal osteomyelitis is A54.43 (sometimes written as A5443). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is A54.43 (Gonococcal infection of musculoskeletal system) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report gonococcal osteomyelitis on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does A54.43 group to?
When gonococcal osteomyelitis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 456, 457, 458, 548, 549, 550, with relative weights from 0.8741 to 8.4034 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of A54.43?
Under the General Equivalence Mappings, gonococcal osteomyelitis converts to ICD-9-CM 098.59 (gc infect joint NEC). The mapping is approximate, so confirm the match fits the documentation.
What HCC is A54.43?
A54.43 (gonococcal osteomyelitis) maps to CMS-HCC Category 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis), commonly written as HCC 92, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 39 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does A54.43 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, A54.43 adds a risk adjustment factor of about 0.479 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.471 to 0.632 depending on the payment segment). HCC 92 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 92 category page.
