A41.9 vs A48.3
A41.9 and A48.3 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on A48.3
sepsis NOS (A41.9)
A41.9
Sepsis, unspecified organism
BillableUnspecified
- Chapter 1
- Certain infectious and parasitic diseases
- Section
- A30-A49
Use when the record says
- Septicemia NOS
Indexed under
- Sepsis (generalized) (unspecified organism)
- Septicemia
- Sepsis › cryptogenic (generalized) (unspecified organism)
- Sepsis › gangrenous (generalized) (unspecified organism)
- Disorder › tubulo-interstitial › sepsis (of)
A48.3
Toxic shock syndrome
Billable
- Chapter 1
- Certain infectious and parasitic diseases
- Section
- A30-A49
Indexed under
- Shock › toxic, syndrome
- Syndrome › toxic shock
- Toxic › shock syndrome (poisoning)
- Syndrome › shock › toxic
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027