A42.7: Actinomycotic sepsis

Risk adjustment

A42.7 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock0.500 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

A42.7 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52868Billing and Coding: Transesophageal Echocardiography (TEE)
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56625Billing and Coding: Echocardiography
• A56781Billing and Coding: Transthoracic Echocardiography (TTE)