ICD-10 R78.81
Billable / Specific CCBacteremia
About ICD-10-CM R78.81
ICD-10-CM code R78.81 represents Bacteremia. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R78). The 2026 edition of ICD-10-CM R78.81 became effective on October 1, 2025.
Coding Tips for R78.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R78.81 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with R78.81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- sepsis-code to specified infection
Inpatient DRG Impact, CC
codes Bacteremia. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for R78.81
Local Coverage Determinations (LCDs) from CMS MACs that list R78.81 as a covered diagnosis.
Showing top 10 of 736 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R78.81.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with R78.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert R78.81 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| R78.81 | 77183 | 10000 |
| R78.81 | 7907 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R78.81
Other codes in section R70-R79 (Abnormal findings on examination of blood, without diagnosis).
ICD-10 R78.81, Billing FAQ
Is ICD-10 code R78.81 billable? +
Yes, R78.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for R78.81? +
Type 1 Excludes (never code together with R78.81): sepsis-code to specified infection
Is R78.81 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does R78.81 map to? +
Per CMS GEMs, R78.81 maps to ICD-9 codes: 77183, 7907. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 17, 2026.
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