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v1.0.0
ICD-10 Guide
ICD-10 CodesA40.3

A40.3

Sepsis due to streptococcus, group B

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 A40.3 is a billable code used to indicate a diagnosis of sepsis due to streptococcus, group b.

Key Diagnostic Point:

Sepsis due to Group B Streptococcus (GBS) is a severe systemic infection that arises from the presence of GBS bacteria in the bloodstream. GBS is a common bacterium found in the gastrointestinal and genitourinary tracts of healthy adults, but it can cause serious infections, particularly in vulnerable populations such as newborns, pregnant women, and the elderly. In newborns, GBS can lead to early-onset sepsis, which occurs within the first week of life, or late-onset sepsis, which occurs after the first week. Symptoms of sepsis include fever, chills, rapid heart rate, confusion, and difficulty breathing. The condition can progress rapidly, leading to septic shock and multi-organ failure, necessitating immediate medical intervention. Treatment typically involves the administration of broad-spectrum antibiotics, followed by targeted therapy based on culture results. ICU care may be required for severe cases, emphasizing the importance of antimicrobial stewardship to prevent resistance and ensure effective treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between sepsis and other infections
  • Identifying the specific strain of streptococcus
  • Documenting the severity of the sepsis
  • Understanding the patient's underlying conditions

Audit Risk Factors

  • Inadequate documentation of the causative organism
  • Failure to document the severity of sepsis
  • Lack of clarity on the patient's clinical status
  • Inconsistent use of terminology related to sepsis

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on the patient's infection history, laboratory results, and treatment response.

Common Clinical Scenarios

Patients presenting with fever and signs of systemic infection, particularly in high-risk populations.

Billing Considerations

Documentation must clearly indicate the source of infection and any relevant comorbidities.

Pediatrics

Documentation Requirements

Thorough documentation of maternal GBS status, neonatal symptoms, and treatment protocols.

Common Clinical Scenarios

Newborns presenting with signs of sepsis, especially in the first week of life.

Billing Considerations

Special attention to the timing of symptom onset and maternal history is crucial.

Coding Guidelines

Inclusion Criteria

Use A40.3 When
  • According to ICD
  • 10 guidelines, A40
  • 3 should be used when the sepsis is specifically due to Group B Streptococcus
  • Coders must ensure that the diagnosis is supported by clinical documentation and laboratory results

Exclusion Criteria

Do NOT use A40.3 When
  • Exclusion criteria include cases where the infection is due to other organisms

Related CPT Codes

87070CPT Code

Culture, bacterial, any source

Clinical Scenario

Used to confirm the presence of GBS in a patient suspected of sepsis.

Documentation Requirements

Document the source of the culture and clinical indications for testing.

Specialty Considerations

Infectious disease specialists may require additional details on the patient's history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sepsis cases, including the identification of the causative organism, which enhances data accuracy and improves patient care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sepsis cases, including the identification of the causative organism, which enhances data accuracy and improves patient care management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sepsis cases, including the identification of the causative organism, which enhances data accuracy and improves patient care management.

Resources

Clinical References

  • •
    CDC Guidelines for the Prevention of Group B Streptococcal Disease

Coding & Billing References

  • •
    CDC Guidelines for the Prevention of Group B Streptococcal Disease

Frequently Asked Questions

What is the significance of coding A40.3 accurately?

Accurate coding of A40.3 is crucial for appropriate treatment, resource allocation, and tracking of infection trends. It also impacts reimbursement and quality metrics in healthcare.