2027 ICD-10-CM Diagnosis Code A54.86Gonococcal sepsis
ICD-10-CM Codes›A00–B99›A50-A64›A54
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 2
- Not Chronic
A54.86 is a billable ICD-10-CM diagnosis code for gonococcal sepsis. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 870 through 872. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 46 closely related codes. Coders also document this condition as gonococcemia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Septicemia and Sexually transmitted infections (excluding HIV and hepatitis).
For Medicare Advantage risk adjustment, A54.86 maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) under the V28 model, adding a risk factor of about 0.500 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
A54.86 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 2027.
Source: CMS Payment Year 2027 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.
- Gonococcemia
- Sepsis caused by Gonococcus
- Septic shock co-occurrent with acute organ dysfunction due to Gonococcus
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to A54.86: its own notes plus those printed at block A50-A64 and Chapter 1. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- diseases generally recognized as communicable or transmissible
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- human immunodeficiency virus [HIV] disease (B20)
- carrier or suspected carrier of infectious disease (Z22.-)
- certain localized infections - see body system-related chapters
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)
- infectious and parasitic diseases specific to the perinatal period (P35-P39)
- influenza and other acute respiratory infections (J00-J22)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify resistance to antimicrobial drugs (Z16.-)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name A54.86, its category, or a range that includes it.
Applicable To 1
These notes mention A54.86.
Excludes2 2
These codes carry an Excludes2 note naming A54.86: its condition is not part of those codes, and both may be reported when the patient has both.
- A41 Other sepsissepsis (due to) (in) gonococcal (A54.86)
- Block P35-P39 Infections specific to the perinatal periodcongenital gonococcal infection (A54.-) names A54.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Gonococcemia A54.86
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Gonococcal Infection
an infection that is caused by gonococcus.
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 A54.86 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About A54.86Overview
What is the ICD-10 code for gonococcal sepsis?
The ICD-10-CM code for gonococcal sepsis is A54.86 (sometimes written as A5486). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is A54.86 (Other gonococcal infections) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report gonococcal sepsis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does A54.86 group to?
When gonococcal sepsis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 872, 871, 870, with relative weights from 1.0066 to 6.9432 depending on complications. Higher weights mean higher Medicare reimbursement.
Is A54.86 a CC or MCC?
CMS lists A54.86 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 46 closely related codes in its exclusion list.
Can A54.86 be reported with N34.1?
Not as a rule. The Excludes1 note at block A50-A64, which applies to A54.86, lists "nonspecific and nongonococcal urethritis (N34.1)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is A54.86?
A54.86 (gonococcal sepsis) maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock), commonly written as HCC 2, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 2 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 A54.86 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, A54.86 adds a risk adjustment factor of about 0.500 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.447 to 0.780 depending on the payment segment). HCC 2 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 2 category page.
