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B95.1

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🎗️ICD-10-CM B95.1 — Streptococcus, Group B, as the Cause of Diseases Classified Elsewhere

Clinical Definition

ICD-10-CM B95.1 identifies Group B Streptococcus (GBS) as the causative organism of a condition coded elsewhere. This code does not describe the disease itself—it supplements another ICD‑10‑CM code by specifying that GBS is the infectious agent.

Group B Streptococcus is commonly associated with:

  • Skin and soft‑tissue infections
  • Urinary tract infections
  • Pneumonia
  • Bacteremia
  • Bone/joint infections
  • Perinatal infections (coded elsewhere in P‑chapter)

This code is never sequenced first and is not a principal diagnosis. It is used in addition to the primary condition code.

Coding Guidance

Key Rules

  • Use B95.1 only when the provider documents Group B Streptococcus as the organism causing another condition.
  • This code cannot stand alone; it must accompany a disease code (e.g., cellulitis, pneumonia, UTI).
  • Do not use for “Streptococcus, unspecified” — use B95.5 instead.
  • Do not use for perinatal infections — use P35-P39.
  • Add Z16.- if antimicrobial resistance is documented.

Sequencing

  • Never principal diagnosis.
  • Sequence the underlying condition first, then add B95.1 to identify the organism.

Includes / Excludes

Includes

  • Group B Streptococcus as the cause of diseases classified elsewhere
  • GBS infection identified by culture or molecular testing
  • GBS bacteremia when linked to another condition

Excludes

  • Streptococcus unspecified — B95.5
  • Carrier/suspected carrier — Z22.-
  • Perinatal GBS infections — P36
  • Other bacterial agents — B96.89

Code Tree


B95-B97 Bacterial and viral infectious agents 
├── B95 Streptococcus, Staphylococcus, and Enterococcus as cause of diseases elsewhere 
│ ├── B95.0 Streptococcus, group A 
│ ├── B95.1 Streptococcus, group B 
│ ├── B95.2 Streptococcus, group D 
│ ├── B95.3 Streptococcus pneumoniae 
│ ├── B95.4 Other streptococcus 
│ └── B95.5 Streptococcus, unspecified 
├── B96 Other bacterial agents 
└── B97 Viral agents

MS‑DRG Impact

Because B95.1 is a supplementary organism code, its DRG impact depends on the primary condition.
However, it is grouped under the following DRGs when paired with infectious diagnoses:

  • DRG 867 — Other infectious & parasitic diseases with MCC
  • DRG 868 — Other infectious & parasitic diseases with CC
  • DRG 869 — Other infectious & parasitic diseases without CC/MCC

HCC Impact

  • No HCC assignment.
    This code identifies an organism only and does not represent a condition included in risk‑adjustment models.

Documentation Requirements

Provider documentation should clearly state:

  • Group B Streptococcus as the causative organism
  • The underlying disease process (e.g., cellulitis, pneumonia, UTI)
  • Clinical evidence supporting infection
  • Culture or lab confirmation when available
  • Any antimicrobial resistance (add Z16.- if documented)

Coding Examples

Example 1

Documentation:
“Cellulitis of left leg due to Group B Streptococcus.”

Codes:

  • L03.116 — Cellulitis of left lower limb
  • B95.1 — GBS as causative organism

Example 2

Documentation:
“GBS urinary tract infection.”

Codes:

  • N39.0 — UTI, site not specified
  • B95.1 — Group B Streptococcus as cause

Example 3

Documentation:
“Pneumonia due to Group B Streptococcus.”

Codes:

  • J15.3 — Pneumonia due to streptococcus, group B
  • B95.1 may be added if the provider explicitly links the organism as causative (optional depending on coding guidelines)

Example 4

Documentation:
“Sepsis due to GBS.”

Codes:

  • A40.1 — Sepsis due to Streptococcus, group B
  • B95.1 is not needed because the organism is already inherent in the A40.1 code
  • B95.0 — Streptococcus, group A
  • B95.2 — Streptococcus, group D
  • B95.5 — Streptococcus, unspecified
  • B96.89 — Other specified bacterial agents
  • Z16.- — Antimicrobial resistance

Notes for Auditors & Coders

  • Confirm that the organism is Group B Streptococcus, not unspecified streptococcus.
  • Ensure the underlying condition is coded first.
  • Do not assign B95.1 when the disease code already includes the organism (e.g., A40.1).
  • Query when documentation is unclear regarding organism identification.

Sources

ICD‑10‑CM B95.1 definition and DRG grouping
Supplementary organism coding rules
Streptococcus group B classification

Graph View

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