A48.3: Toxic shock syndrome
A48.3 is a billable, specific ICD-10-CM code for toxic shock syndrome. It is valid for submission on a claim.
Check A48.3 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Use additional code
Add a secondary code to capture the detail described below.
Other codes that can never be billed with A48.3
Their own Excludes1 notes name this code, so the conflict is not listed above.
- R57Shock, not elsewhere classified
Risk adjustment
A48.3 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
A48.3 is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A59105Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Alphabetic index entries that lead here
- Shock›toxic, syndrome
- Syndrome›toxic shock
- Toxic›shock syndrome
- Syndrome›shock›toxic
Code history
Unchanged in every release from FY2024 to FY2027.