P36.4
P36.4: Sepsis of newborn due to Escherichia coli
Billable / specific codeICD-10-CM
P36.4 is a billable, specific ICD-10-CM code for sepsis of newborn due to escherichia coli. It is valid for submission on a claim.
Check P36.4 with the rest of the claim: free scrubberOther codes that can never be billed with P36.4
Their own Excludes1 notes name this code, so the conflict is not listed above.
- A41Other sepsis
Risk adjustment
P36.4 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
P36.4 is named in 2 Medicare coverage policies: 2 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A57224Billing and Coding: Respiratory Care
Alphabetic index entries that lead here
- Infection, infected, infective›Escherichia coli NEC›congenital›sepsis
- Newborn›sepsis›due to›Escherichia coli
- Sepsis›newborn›due to›Escherichia coli
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under P36
- P36.0Sepsis of newborn due to streptococcus, group B
- P36.1Sepsis of newborn due to other and unspecified streptococci
- P36.2Sepsis of newborn due to Staphylococcus aureus
- P36.3Sepsis of newborn due to other and unspecified staphylococci
- P36.5Sepsis of newborn due to anaerobes
- P36.8Other bacterial sepsis of newborn
- P36.9Bacterial sepsis of newborn, unspecified