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v1.0.0
ICD-10 Guide
ICD-10 CodesA43.1

A43.1

Sepsis due to anaerobes

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

Code Description

ICD-10 A43.1 is a billable code used to indicate a diagnosis of sepsis due to anaerobes.

Key Diagnostic Point:

Sepsis due to anaerobes is a serious and potentially life-threatening condition characterized by the presence of anaerobic bacteria in the bloodstream, leading to systemic inflammatory response syndrome (SIRS). Anaerobes are bacteria that thrive in environments devoid of oxygen, and they can be opportunistic pathogens, particularly in immunocompromised patients. Common sources of anaerobic infections include abscesses, necrotizing fasciitis, and infections following surgical procedures. Patients with weakened immune systems, such as those undergoing chemotherapy, living with HIV/AIDS, or those with chronic diseases, are at heightened risk for developing sepsis from anaerobic organisms. The clinical presentation may include fever, chills, tachycardia, hypotension, and altered mental status. Diagnosing sepsis due to anaerobes can be challenging due to the nonspecific nature of symptoms and the need for specific cultures to identify the causative organisms. Prompt recognition and treatment are critical, as delays can lead to increased morbidity and mortality.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Identification of anaerobic organisms requires specific culture techniques.
  • Differentiating between sepsis due to anaerobes and other types of sepsis can be clinically challenging.
  • Documentation must clearly indicate the source of infection and the patient's immunocompromised status.
  • Coding may require additional codes to capture underlying conditions contributing to immunocompromise.

Audit Risk Factors

  • Inadequate documentation of the source of infection.
  • Failure to document the patient's immunocompromised status.
  • Incorrect coding of the causative organism.
  • Lack of clarity in the clinical notes regarding the diagnosis of sepsis.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on the patient's history, physical examination findings, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever and signs of infection, particularly those with recent surgeries or chronic illnesses.

Billing Considerations

Ensure that all relevant cultures and sensitivities are documented to support the diagnosis.

Critical Care

Documentation Requirements

Comprehensive documentation of vital signs, treatment interventions, and response to therapy.

Common Clinical Scenarios

Patients in the ICU with severe sepsis or septic shock requiring intensive monitoring and treatment.

Billing Considerations

Document the progression of the patient's condition and any changes in treatment plans.

Coding Guidelines

Inclusion Criteria

Use A43.1 When
  • According to ICD
  • 10 coding guidelines, A43
  • 1 should be used when sepsis is confirmed to be due to anaerobic bacteria
  • Coders must ensure that the documentation supports the diagnosis and that any underlying conditions contributing to the patient's immunocompromised state are also coded

Exclusion Criteria

Do NOT use A43.1 When
No specific exclusions found.

Related CPT Codes

87070CPT Code

Culture, bacterial, aerobic and anaerobic

Clinical Scenario

Used when blood cultures are taken to identify the causative organism in suspected sepsis.

Documentation Requirements

Document the reason for the culture and any relevant clinical findings.

Specialty Considerations

Infectious disease specialists should ensure that culture results are clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sepsis, including the identification of anaerobic infections, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sepsis, including the identification of anaerobic infections, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sepsis, including the identification of anaerobic infections, which enhances data accuracy and improves patient care tracking.

Resources

Clinical References

  • •
    CDC Sepsis Guidelines

Coding & Billing References

  • •
    CDC Sepsis Guidelines

Frequently Asked Questions

What are the common anaerobic bacteria associated with sepsis?

Common anaerobic bacteria include Bacteroides, Clostridium, and Fusobacterium species. These organisms can cause infections in various body sites, particularly in immunocompromised patients.