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ICD-10 Guide
ICD-10 CodesA54.86

A54.86

Gonococcal sepsis

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

Code Description

ICD-10 A54.86 is a billable code used to indicate a diagnosis of gonococcal sepsis.

Key Diagnostic Point:

Gonococcal sepsis is a severe systemic infection caused by the bacterium Neisseria gonorrhoeae, which is primarily known for causing gonorrhea, a common sexually transmitted infection (STI). This condition arises when the bacteria enter the bloodstream, leading to widespread inflammation and potential organ dysfunction. Symptoms may include fever, chills, malaise, and signs of septic shock, such as hypotension and altered mental status. Gonococcal sepsis can occur in both men and women, often as a complication of untreated gonorrhea, particularly in individuals with risk factors such as immunosuppression or concurrent STIs. Diagnosis typically involves blood cultures, which may reveal the presence of Neisseria gonorrhoeae. Prompt recognition and treatment are crucial, as untreated gonococcal sepsis can lead to severe morbidity and mortality. Treatment usually involves intravenous antibiotics, with ceftriaxone being the first-line therapy. Contact tracing and treatment of sexual partners are essential components of managing gonococcal infections to prevent reinfection and further transmission.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of both infectious disease and sepsis coding.
  • Differentiation from other types of sepsis and STIs.
  • Need for accurate documentation of clinical presentation and laboratory findings.
  • Potential for co-infection with other STIs complicating the clinical picture.

Audit Risk Factors

  • Inadequate documentation of clinical symptoms and laboratory results.
  • Failure to document the presence of sepsis criteria.
  • Lack of clear linkage between diagnosis and treatment provided.
  • Inconsistent coding of co-infections or related conditions.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and treatment plans.

Common Clinical Scenarios

Management of patients with confirmed gonococcal infections presenting with systemic symptoms.

Billing Considerations

Need for thorough documentation of sexual history and partner treatment.

Emergency Medicine

Documentation Requirements

Comprehensive assessment notes, including vital signs and sepsis screening.

Common Clinical Scenarios

Patients presenting with fever and hypotension, suspected of having sepsis.

Billing Considerations

Rapid documentation of clinical findings to support sepsis diagnosis.

Coding Guidelines

Inclusion Criteria

Use A54.86 When
  • According to ICD
  • 10 coding guidelines, A54
  • 86 should be used when there is clear documentation of gonococcal sepsis, supported by clinical findings and laboratory results
  • It is important to ensure that the diagnosis is not coded without evidence of systemic infection

Exclusion Criteria

Do NOT use A54.86 When
No specific exclusions found.

Related CPT Codes

87591CPT Code

Nucleic acid amplification test for Neisseria gonorrhoeae

Clinical Scenario

Used for confirming gonococcal infection in patients presenting with symptoms.

Documentation Requirements

Document the reason for testing and results.

Specialty Considerations

Infectious disease specialists may require additional details on patient history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, including the ability to capture the severity of conditions like gonococcal sepsis, which was less detailed in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, including the ability to capture the severity of conditions like gonococcal sepsis, which was less detailed in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, including the ability to capture the severity of conditions like gonococcal sepsis, which was less detailed in ICD-9.

Resources

Clinical References

  • •
    CDC Gonorrhea Treatment Guidelines

Coding & Billing References

  • •
    CDC Gonorrhea Treatment Guidelines

Frequently Asked Questions

What are the primary symptoms of gonococcal sepsis?

Primary symptoms include fever, chills, malaise, hypotension, and signs of septic shock. Patients may also present with localized symptoms depending on the site of infection.