Crystal's Coder Hub🦠 ICD-10 CM T80.211A — Bloodstream Infection Due to Central Venous Catheter, Initial Encounter
Billable Code Confirmed
ICD-10-CM T80.211A is a valid, billable 8-character ICD-10-CM diagnosis code (T80.211 + 7th character A) for FY2026. Characters 1-3 (T80) identify the category as complications following infusion, transfusion, and therapeutic injection; character 4 (.2) specifies infections; character 5 (1) specifies central venous catheter; character 6 (1) designates bloodstream infection specifically (as opposed to local infection — T80.212X); the 7th character A designates initial encounter (active treatment phase). All characters are required.
Non-Billable Parent Codes — Never Submit These
- ❌
T80— 3-character category — does not specify type of complication- ❌
T80.2— 5-character subcategory — specifies infection type only, not site- ❌
T80.21— 6-character subcategory — specifies CVC, but not bloodstream vs. local vs. other infection- ❌
T80.211— 7-character code — requires 7th character; not billable without A/D/SAlways submit T80.211A (initial encounter — active treatment), T80.211D (subsequent encounter), or T80.211S (sequela) depending on the encounter phase.
7th Character — Active Treatment Governs "A," Not First Visit
Per ICD-10-CM Official Guidelines, the 7th character A (initial encounter) is assigned throughout the entire active treatment phase — not just the first visit. A patient readmitted 2 weeks after CLABSI diagnosis who is still on antibiotics targeting the CVC infection still receives T80.211A. The 7th character D (subsequent encounter) is used for routine follow-up after active treatment has concluded. The 7th character S (sequela) is assigned when a late effect of the CVC infection is the focus of care. In most inpatient scenarios involving active CLABSI management, T80.211A is the correct 7th character.
HAC Status — Hospital-Acquired Condition Alert
T80.211A — CLABSI — is designated as a Hospital-Acquired Condition (HAC) under the CMS HAC Reduction Program (HAC Category: Central Line-Associated Bloodstream Infection). When T80.211A is present on admission (POA) = “N” (not present on admission), it may disqualify the case from receiving MCC/CC DRG weight for that secondary diagnosis and can trigger a payment reduction under the HAC Reduction Program. POA indicator accuracy is critical: if the CVC was placed prior to admission and the CLABSI was present on admission, POA = “Y” preserves MCC/CC credit. If CLABSI developed after admission, POA = “N” triggers HAC penalties. Always verify POA status with clinical documentation.
🔍 Code Description
ICD-10-CM T80.211A classifies a bloodstream infection attributable to a central venous catheter (CVC), captured during the initial/active treatment encounter. This entity — known clinically as CLABSI (Central Line-Associated Bloodstream Infection) or CRBSI (Catheter-Related Bloodstream Infection) — represents the systemic invasion of a microorganism into the bloodstream via the intravascular segment of a central venous catheter, its hub, or the insertion site tract. Common causative organisms include coagulase-negative staphylococci (e.g., S. epidermidis — B95.7), MRSA (B95.62), Klebsiella pneumoniae (B96.1), Candida species (B37.7), and gram-negative bacilli including E. coli (B96.20).
Pathophysiologically, CLABSI arises via three mechanisms: (1) extraluminal migration of skin flora along the outer catheter surface at the insertion site — most common for short-term CVCs; (2) intraluminal contamination of the hub or infusate — predominant for long-term catheters; (3) hematogenous seeding from a distant infection source. The infection can manifest clinically as bacteremia/fungemia with or without systemic sepsis response — when sepsis criteria are met, a concurrent sepsis code (A41.x) must be assigned in addition to T80.211A.
🌳 Code Tree / Hierarchy
T80 Complications following infusion, transfusion and therapeutic injection ❌ Non-billable
│ Includes: complications following perfusion
│ Use additional code for adverse effect (if applicable) to identify drug
│
├── T80.0 Air embolism following infusion, transfusion and therapeutic injection ❌ Non-billable
│
├── T80.1 Vascular complications following infusion, transfusion and therapeutic injection ❌ Non-billable
│
├── T80.2 Infections following infusion, transfusion and therapeutic injection ❌ Non-billable
│ │ Excludes2: infections due to prosthetic devices/implants/grafts (T82.6-, T82.7-, T83.5-, T84.5-, T85.7-)
│ │ postprocedural infections (T81.4-)
│ │ Use additional code (R65.2-) to identify severe sepsis, if applicable
│ │
│ ├── T80.21 Infection due to central venous catheter ❌ Non-billable
│ │ │
│ │ ├── T80.211 Bloodstream infection due to central venous catheter ❌ Non-billable
│ │ │ ├── ▶▶ T80.211A ◀◀ Bloodstream infection due to CVC, initial encounter ← YOU ARE HERE ✅ Billable
│ │ │ ├── T80.211D Bloodstream infection due to CVC, subsequent encounter ✅ Billable
│ │ │ └── T80.211S Bloodstream infection due to CVC, sequela ✅ Billable
│ │ │
│ │ ├── T80.212 Local infection due to central venous catheter ❌ Non-billable
│ │ │ ├── T80.212A Local infection due to CVC, initial encounter ✅ Billable
│ │ │ ├── T80.212D Local infection due to CVC, subsequent encounter ✅ Billable
│ │ │ └── T80.212S Local infection due to CVC, sequela ✅ Billable
│ │ │
│ │ ├── T80.218 Other infection due to central venous catheter ❌ Non-billable
│ │ │ ├── T80.218A Other infection due to CVC, initial encounter ✅ Billable
│ │ │ ├── T80.218D Other infection due to CVC, subsequent encounter ✅ Billable
│ │ │ └── T80.218S Other infection due to CVC, sequela ✅ Billable
│ │ │
│ │ └── T80.219 Unspecified infection due to central venous catheter ❌ Non-billable
│ │ ├── T80.219A Unspecified infection due to CVC, initial encounter ✅ Billable
│ │ ├── T80.219D Unspecified infection due to CVC, subsequent encounter ✅ Billable
│ │ └── T80.219S Unspecified infection due to CVC, sequela ✅ Billable
│ │
│ └── T80.29 Other infection following infusion, transfusion, injection ❌ Non-billable
│ ├── T80.29XA ✅ Billable
│ ├── T80.29XD ✅ Billable
│ └── T80.29XS ✅ Billable
│
├── T80.3 ABO incompatibility reaction ❌ Non-billable
├── T80.4 Rh incompatibility reaction ❌ Non-billable
├── T80.5 Anaphylactic reaction due to serum ❌ Non-billable (see T80.51XA)
├── T80.6 Other serum reactions ❌ Non-billable
├── T80.8 Other complications following infusion, transfusion, injection ❌ Non-billable
└── T80.9 Unspecified complication following infusion, transfusion, injection ❌ Non-billable
Bloodstream (T80.211A) vs. Local (T80.212A) vs. Other (T80.218A) CVC Infection
Code selection within the T80.21x family depends on the extent and type of infection documented by the provider:
- T80.211A — Bloodstream infection (CLABSI): Positive blood culture(s) with clinical signs of systemic infection attributable to the CVC — the pathogen is in the bloodstream
- T80.212A — Local infection: Exit site infection, tunnel infection, or port-pocket infection without documented bloodstream involvement — cellulitis, purulent drainage at insertion site, but negative blood cultures
- T80.218A — Other CVC infection: Catheter-related infection not fitting the bloodstream or local categories (e.g., septic thrombophlebitis)
- T80.219A — Unspecified CVC infection: Use only when the type of CVC infection is genuinely not documented — never default here when blood culture results and clinical documentation support a specific category
✅ Includes
The following clinical terms and scenarios map to T80.211A during initial/active treatment:
- CLABSI — Central line-associated bloodstream infection (CDC/NHSN definition)
- CRBSI — Catheter-related bloodstream infection with confirmed CVC source
- Bacteremia due to central venous catheter (confirmed or clinically attributed)
- Fungemia due to central venous catheter (e.g., Candida bloodstream infection via CVC)
- Septicemia attributable to central venous catheter
- Bloodstream infection from tunneled catheter (Hickman, Broviac), PICC line, non-tunneled triple-lumen CVC, or port-a-cath when manifesting as bloodstream infection
- CVC-associated bacteremia/septicemia, initial active treatment
❌ Excludes
Excludes 2 — May Be Coded in Addition if Separately Present
| Code | Description | Note |
|---|---|---|
| T82.7- | Infection/inflammatory reaction due to other cardiac and vascular devices, implants and grafts | When infection involves a fully implanted vascular device (AV graft, vascular stent) — distinct from temporary CVC; code separately when both are present |
| T85.7- | Infection/inflammatory reaction due to other internal prosthetic devices | When infection involves an implanted subcutaneous port (Port-a-Cath), the T85.7x family may apply instead of T80.211A — provider documentation and clinical distinction between intraluminal CVC infection and port pocket/reservoir infection governs code selection |
| T81.4- | Infection following a procedure | Post-procedural wound infections at a separate site; separately codeable when both a surgical site infection and a CLABSI co-exist |
| A41.x | Sepsis (various organisms) | Most critical additional code — when CLABSI precipitates sepsis, code both T80.211A AND the appropriate sepsis code; the sepsis code typically sequences as principal diagnosis |
| B95.x / B96.x / B97.x | Bacterial and viral infectious agents | Required additional code per T80.2 instructional note — use additional code from B95-B97 to identify the causative organism when documented |
| R65.20 / R65.21 | Severe sepsis without/with septic shock | When severe sepsis criteria are met — use additional code per T80.2 instructional note |
Most Critical Code Pairing — T80.211A + Sepsis Code
The most significant coding action when T80.211A is assigned is to always evaluate for concurrent sepsis documentation. When the provider has documented sepsis in the context of CLABSI, both the sepsis code (A41.x) and T80.211A must be assigned — the sepsis code sequences as principal in most inpatient scenarios (it is the condition meeting criteria for admission), with T80.211A identifying the source. Omitting the sepsis code when sepsis is documented is both a clinical documentation failure and a significant DRG weight miss — the Septicemia DRG family (DRG 870/871/872) carries substantially higher weight than the Other Infectious Diseases DRG family (DRG 867/868/869).
📋 Clinical Overview
7th Character Selection — A vs. D vs. S
| 7th Character | Code | Use When |
|---|---|---|
| A — Initial Encounter | T80.211A | Patient is receiving active treatment for the CLABSI — IV antibiotics, antifungals, catheter management decisions, infectious disease consultation — regardless of whether this is the first, second, or tenth visit for this episode |
| D — Subsequent Encounter | T80.211D | Patient is seen during routine follow-up after active treatment has concluded — monitoring, wound check after line removal site healed, surveillance cultures |
| S — Sequela | T80.211S | Patient presents with a late effect of the prior CLABSI as the focus of care — e.g., endocarditis developing as a sequela, septic emboli, osteomyelitis resulting from prior bacteremia |
Active Treatment = 7th Character A
In the inpatient setting, essentially every admission for CLABSI management will use T80.211A — IV antimicrobial therapy, CVC removal and replacement decision-making, and ID consultation all constitute “active treatment.” The 7th character does not track the number of visits; it tracks the phase of care. Even if the patient was started on outpatient IV antibiotics and then admitted for deterioration, they are still in the active treatment phase — T80.211A applies.
CLABSI vs. CRBSI — Clinical Definitions and Coding Impact
The CDC/NHSN uses CLABSI (Central Line-Associated Bloodstream Infection) as a surveillance definition, while clinicians often use CRBSI (Catheter-Related Bloodstream Infection) as a more stringent diagnostic definition. Both map to T80.211A — the ICD-10-CM code does not distinguish between these surveillance vs. clinical definitions. The provider’s documentation of a bloodstream infection attributable to the CVC is sufficient.
| Feature | CLABSI (CDC/NHSN) | CRBSI (Clinical Diagnosis) |
|---|---|---|
| Definition | Laboratory-confirmed BSI in patient with central line ≥2 days with no other identifiable source | BSI with quantitative cultures or differential time to positivity confirming CVC as source |
| Confirmation Required | No — surveillance definition, no DTP required | Yes — more rigorous, requires catheter tip culture or DTP |
| ICD-10-CM Code | T80.211A | T80.211A |
| HAC Reporting | NHSN CLABSI rate reported to CMS | Clinical CRBSI diagnosis drives provider notes |
| Coding Guidance | Provider diagnosis governs — do not query NHSN CLABSI data for code assignment | Assign based on provider’s clinical diagnosis documentation |
Coding Manifestations — Required and Optional Additional Codes
Per the T80.2 Use Additional Code instruction, the following are required or strongly recommended when documented:
- B95.62 — MRSA as causative organism (MCC — drives DRG 867 with MCC)
- B95.61 — MSSA as causative organism
- B37.7 — Candidal septicemia (when fungemia is the CLABSI organism)
- A41.89 — Other specified sepsis (when sepsis is documented and organism is specified)
- A41.9 — Sepsis, unspecified organism (when sepsis is documented but organism is not specified)
- R65.21 — Severe sepsis with septic shock (MCC — when septic shock complicates CLABSI)
- Z79.2 — Long-term (current) use of antibiotics (when prolonged antibiotic course is documented)
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (Fully operative — Payment Year 2026) |
| HCC Assignment | ❌ Not HCC-Mapped |
| HCC Category | N/A |
| RAF Coefficient | N/A |
T80.211A does not map to an HCC category under CMS-HCC v28. As a complication code with a 7th character (acute/initial encounter), it is not modeled as a chronic condition for risk adjustment purposes.
HCC Opportunity — Code Concurrent Sepsis
When a patient with a Medicare Advantage plan is admitted for CLABSI-associated sepsis, the sepsis code (A41.x) maps to HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) under CMS-HCC v28 — one of the highest-weighted HCCs with a substantial RAF coefficient. T80.211A itself carries no HCC weight, but the clinical context almost always presents an HCC capture opportunity through the concurrent sepsis diagnosis. Capture all documented concurrent conditions (septic shock, acute kidney injury, respiratory failure) as these may also carry HCC weight.
🏥 MS-DRG Assignment
MDC 18 — Infectious and Parasitic Diseases, Systemic or Unspecified Sites (when T80.211A is principal)
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 867 | Other Infectious and Parasitic Diseases Diagnoses with MCC | ~2.5-3.2 |
| DRG 868 | Other Infectious and Parasitic Diseases Diagnoses with CC | ~1.4-1.8 |
| DRG 869 | Other Infectious and Parasitic Diseases Diagnoses without CC/MCC | ~0.8-1.1 |
Approximate. Verify against IPPS FY2026 Final Rule tables (CMS v43.1 MS-DRG Definitions Manual, effective April 1, 2026).
Sequencing: CLABSI + Sepsis = Septicemia DRG Family (Higher Weight)
When CLABSI causes sepsis, A41.x (sepsis) typically sequences as the principal diagnosis (the condition that drove the admission), with T80.211A as a secondary code identifying the source. This shifts the DRG from the Other Infectious/Parasitic Diseases family (DRG 867/868/869) to the Septicemia/Severe Sepsis family (DRG 870/871/872) — a substantially higher-weighted DRG family. Correct sequencing in CLABSI + sepsis cases is therefore not only a clinical accuracy requirement but a significant DRG weight driver. Additionally, [[T80.211A]] as a secondary diagnosis (when the principal is a non-infectious primary admission) functions as an MCC in many DRG groupings — activating the highest CC/MCC tier. HAC POA = “N” status negates this MCC credit — document and report POA accurately.
🔗 Related ICD-10-CM Codes
T80.21x Family — CVC Infection by Type and 7th Character
| Code | Description |
|---|---|
| T80.211A | Bloodstream infection due to CVC, initial encounter ← This Code |
| T80.211D | Bloodstream infection due to CVC, subsequent encounter |
| T80.211S | Bloodstream infection due to CVC, sequela |
| T80.212A | Local infection due to CVC, initial encounter |
| T80.218A | Other infection due to CVC, initial encounter |
| T80.219A | Unspecified infection due to CVC, initial encounter |
Causative Organism Codes (Required Additional — B95-B97)
| Code | Description |
|---|---|
| B95.61 | MSSA as the cause of diseases classified elsewhere |
| B95.62 | MRSA as the cause of diseases classified elsewhere |
| B95.7 | Other staphylococcus as the cause (e.g., S. epidermidis — CoNS) |
| B96.1 | Klebsiella pneumoniae as the cause |
| B96.20 | Unspecified E. coli as the cause |
| B37.7 | Candidal septicemia |
Concurrent Sepsis and Severity Codes
| Code | Description |
|---|---|
| A41.9 | Sepsis, unspecified organism |
| A41.89 | Other specified sepsis |
| R65.20 | Severe sepsis without septic shock |
| R65.21 | Severe sepsis with septic shock |
🛠️ Commonly Associated CPT Codes
Profee and Outpatient Context
T80.211A supports blood culture collection and analysis, infectious disease consultation, and central line management procedures. In the inpatient setting, the code supports daily ID consultation E/M services and CVC removal/replacement procedures.
| CPT Code | Description | Profee Coding Notes |
|---|---|---|
| 87040 | Culture, bacterial; blood, aerobic, with isolation and presumptive identification | Primary blood culture code — aerobic; bill per specimen; required for CLABSI diagnosis confirmation |
| 87046 | Culture, bacterial; blood, additional isolates | Anaerobic blood culture — separate billing from 87040 |
| 87070 | Culture, bacterial; any other source except urine, blood or stool | Catheter tip culture — essential for CRBSI confirmation when catheter is removed; specimen source = catheter tip |
| 87186 | Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) | Antimicrobial susceptibility testing to guide targeted antibiotic therapy |
| 87185 | Beta-lactamase production test | For MRSA/resistant organism characterization |
| 36558 | Insertion of tunneled centrally inserted central venous catheter; age 5 years or older | CVC replacement when infected line is removed |
| 36589 | Removal of tunneled central venous catheter, without subcutaneous port or pump | CVC removal as part of CLABSI management; document clinical indication |
| 99253 / 99254 / 99255 | Inpatient consultation (initial), moderate/high complexity | Infectious disease consultation E/M for CLABSI management; -GC modifier required under Medicare if applicable |
NCCI Bundling Considerations
- 87040 and 87046 (aerobic and anaerobic blood cultures): These are separately billable when each culture method is performed — do not combine. Each represents a distinct diagnostic service.
- 36558 (CVC insertion) and 36589 (CVC removal): These may be billed together when infected CVC is removed and a new CVC is placed at a different site on the same date — document separate sites and clinical indication for each.
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 0 (Medical and Surgical) | 2 (Heart and Great Vessels) | P (Removal) | CVC removal from superior vena cava (internal jugular/subclavian approach): 02PV33Z — Removal of Infusion Device from Superior Vena Cava, Percutaneous |
| 0 (Medical and Surgical) | 2 (Heart and Great Vessels) | H (Insertion) | New CVC placement after removal: 02HV33Z — Insertion of Infusion Device into Superior Vena Cava, Percutaneous |
| 0 (Medical and Surgical) | 6 (Lower Veins) | P (Removal) | Femoral CVC removal: 06PY33Z — Removal of Infusion Device from Lower Vein, Percutaneous |
| 3 (Administration) | 3 (Peripheral Vein) | 0 (Introduction) | IV antibiotic administration via peripheral access: 3E033XZ — Introduction into Peripheral Vein, Percutaneous |
PCS Character Analysis — 02PV33Z
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical |
| 2 | Body System | 2 | Heart and Great Vessels |
| 3 | Root Operation | P | Removal (taking out or off a device from a body part — infusion device/catheter) |
| 4 | Body Part | V | Superior Vena Cava |
| 5 | Approach | 3 | Percutaneous |
| 6 | Device | 3 | Infusion Device (the CVC) |
| 7 | Qualifier | Z | No Qualifier |
💊 Coding Scenarios and Examples
Scenario 1 — Inpatient: CLABSI with Sepsis Due to MRSA
Clinical Vignette: A 58-year-old male with end-stage renal disease on hemodialysis is admitted from the dialysis center with fever (39.8°C), rigors, and hypotension. He has a tunneled hemodialysis catheter (right internal jugular). Blood cultures drawn from both the catheter hub and a peripheral vein grow MRSA. ID consultation is obtained. The attending documents: “MRSA bacteremia/sepsis due to infected tunneled hemodialysis catheter — plan for catheter removal and IV vancomycin 6 weeks per ID.” The patient is hemodynamically stabilized in the ICU.
Principal Diagnosis:
- A41.02 — Sepsis due to methicillin-resistant Staphylococcus aureus (reason for admission — MCC; sequences as principal)
Secondary Diagnoses:
- T80.211A — Bloodstream infection due to central venous catheter, initial encounter (CLABSI source — MCC as secondary)
- B95.62 — MRSA as the cause of diseases classified elsewhere (required organism code per Use Additional Code instruction)
- N18.6 — End-stage renal disease (underlying comorbidity — CC)
- Z99.2 — Dependence on renal dialysis (dialysis status)
MS-DRG Assignment: A41.02 as principal (MCC itself) with T80.211A (MCC) and B95.62 as secondary codes groups to DRG 870 (Septicemia or Severe Sepsis without MV >96 Hours — the MCC tier) — highest weight tier of the Septicemia DRG family.
Scenario 2 — Inpatient: CLABSI Without Sepsis (Local + Bloodstream, Post-Chemo Port)
Clinical Vignette: A 45-year-old female with active breast cancer undergoing chemotherapy presents to the ED with fever and redness/purulent drainage at her Port-a-Cath site. Blood cultures drawn peripherally are positive for coagulase-negative staphylococcus (S. epidermidis). The oncologist documents: “Bloodstream infection and local port site infection due to Port-a-Cath (central venous port) — no sepsis criteria met. Plan for port removal and IV antibiotics.” The infection is confirmed to involve the port’s intravascular catheter component and the port pocket.
Principal Diagnosis:
- T80.211A — Bloodstream infection due to central venous catheter, initial encounter (systemic component — most significant infection)
Secondary Diagnoses:
- T80.212A — Local infection due to central venous catheter, initial encounter (port pocket/exit site infection — separately coded per documentation of both components)
- B95.7 — Other staphylococcus as the cause of diseases classified elsewhere (S. epidermidis / CoNS organism)
- C50.911 — Malignant neoplasm of unspecified site of right female breast (active malignancy — MCC; drives DRG to 867)
MS-DRG Assignment: T80.211A as principal with C50.911 as MCC groups to DRG 867 (Other Infectious and Parasitic Diseases Diagnoses with MCC).
Scenario 3 — HAC POA Scenario: CLABSI Developing Post-Admission
Clinical Vignette: A 72-year-old male is admitted for elective colectomy for colon cancer. A subclavian triple-lumen CVC is placed on post-operative day 1. On post-operative day 6, the patient develops fever and blood cultures grow Candida albicans. ID is consulted and documents: “Candida bloodstream infection — likely central line source (CVC in place 5 days). CLABSI.”
POA (Present on Admission) Indicator:
- T80.211A — POA = N (Not Present on Admission) — the CLABSI developed after admission; the CVC was placed post-admission
Coding Impact of POA = N:
- T80.211A carries MCC status when coded as a secondary diagnosis — however, because POA = “N,” the CMS HAC policy disqualifies this secondary diagnosis from receiving MCC DRG credit, preventing the case from grouping to the MCC tier
- Additionally, this case triggers NHSN CLABSI reporting and CMS HAC Reduction Program scoring, which may reduce the hospital’s overall HAC score
Secondary Diagnoses:
- T80.211A — Bloodstream infection due to CVC, initial encounter (POA = N — HAC; MCC credit disqualified per HAC rules)
- B37.7 — Candidal septicemia (required organism code; Candida fungemia)
- A41.89 — Other specified sepsis (if sepsis criteria are met and documented by attending — MCC; sequences as principal if it drove transfer to ICU)
HAC Documentation Requirement
When T80.211A has POA = “N,” the hospital’s quality team, infection control, and coding department should all be notified. CLABSI is subject to public reporting, CMS HAC Reduction Program penalties, and is tracked by The Joint Commission. Accurate POA assignment is both a billing compliance requirement and a patient safety quality measure.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Omitting the causative organism code (B95-B97). The T80.2 subcategory carries a “Use additional code” instruction to identify the organism — this is a mandatory instructional note, not optional. When the blood culture organism is documented, the appropriate B95.x, B96.x, B97.x, or B37.7 code must be assigned. Omitting the organism code is both a coding guideline violation and a DRG accuracy issue — MRSA (B95.62) is an MCC-level code that elevates DRG grouping independently. |
| ❌ | Failing to code concurrent sepsis when documented. When the provider documents sepsis in the context of CLABSI, both the sepsis code (A41.x) and T80.211A must be assigned. Many coders assign only T80.211A when CLABSI is the focus — but documented sepsis must be coded separately. The sepsis code sequences as principal in most inpatient scenarios, and the DRG weight difference between DRG 867 (CLABSI as principal) and DRG 870/871 (sepsis as principal with CLABSI as source) is substantial. |
| ❌ | Using T80.211A for implanted port infections when T85.7x applies. When the infection is documented as arising specifically from the port reservoir/pocket of a totally implanted port (Port-a-Cath), rather than the intravascular CVC component, T85.79x (infection due to other internal prosthetic devices) may be the more anatomically precise code. Provider documentation of whether the infection involves the intravascular catheter (T80.211x) vs. the implanted port device itself (T85.79x) governs code selection — query when unclear. |
| ✅ | Always assign POA correctly and flag for HAC review. CLABSI is one of CMS’s tracked Hospital-Acquired Conditions. When T80.211A has POA = “N,” the hospital compliance and quality teams must be notified. POA = “Y” (if the infection was truly present at admission) preserves MCC/CC credit. Inaccurate POA assignment in either direction — labeling a pre-existing infection as HAC or failing to flag a true HAC — creates both compliance and payment risk. |
| ✅ | Code both bloodstream (T80.211A) AND local infection (T80.212A) when both are documented. When the provider documents both a local CVC site infection (exit site, tunnel, or port pocket) AND a bloodstream infection from the same catheter, assign both T80.211A and T80.212A — these are distinct manifestations of CVC infection that are separately codeable when both are present and documented. |
📚 Sources
1 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. Section I.C.19 (Chapter 19 — Injury, Poisoning); Section I.C.19.a (7th character selection — initial/subsequent/sequela). https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf
2 CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43.0 / v43.1. MDC 18 Other Infectious and Parasitic Diseases DRG 867/868/869; MDC 18 Septicemia DRG 870/871/872. https://www.cms.gov/icd10m/FY2026-fr-v43.1-fullcode-cms/fullcode_cms/
3 icdlist.com. “2026 ICD-10-CM Diagnosis Code T80.211A — Bloodstream infection due to central venous catheter, initial encounter.” Billability and hierarchy confirmed. https://icdlist.com/icd-10/T80.211A
4 AAPC. “ICD-10-CM Code T80.211A — Bloodstream Infection Due to Central Venous Catheter, Initial Encounter.” T80.2 Excludes2 notation and Use Additional Code instruction confirmed. https://www.aapc.com/codes/icd-10-codes/T80.211A
5 Federal Register. “Medicare Program; Hospital IPPS FY2021 Final Rule.” T80.211A, T80.212A, and T80.218A confirmed in infection due to central venous catheter coding discussion. https://www.federalregister.gov/documents/2020/09/18/2020-19637/medicare-program-hospital-inpatient-prospective-payment-systems
6 CMS. HAC Reduction Program — Hospital-Acquired Condition Listing. CLABSI (Central Line-Associated Bloodstream Infection) designated as HAC under Domain 2 (PSI/HAC measures). https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/hac-reduction-program
7 Texas Children’s Hospital. CLABSI Diagnosis and Management Guideline. Clinical criteria for CLABSI diagnosis: simultaneous central and peripheral blood culture collection, time to positivity methodology. https://www.texaschildrens.org/sites/default/files/uploads/documents/outcomes/standards/CLABSI-Diagnosis-Management-Guideline-FI.pdf
8 AMA. CPT Professional Edition 2026. Microbiology section (87040, 87046, 87070, 87186); Central venous access procedures (36558, 36589).
9 HIA Code. “ICD-10-CM Code Updates — April 1, 2026 (v43.1).” FY2026 tabular changes confirmed; T80.211A unaffected by April 2026 revision cycle. https://hiacode.com/blog/icd-10-cm-code-updates-april-1