ICD-10 Coding for Clostridium difficile infection(A04.71, A04.72)
Complete ICD-10-CM coding and documentation guide for Clostridium difficile infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Clostridium difficile infection
A04.7Primary Range
Other specified bacterial intestinal infections
This range includes specific codes for Clostridium difficile infections, distinguishing between recurrent and non-recurrent cases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A04.71 | Enterocolitis due to Clostridium difficile, recurrent | Use for patients with a documented recurrence of CDI within 8 weeks of a previous episode. |
|
| A04.72 | Enterocolitis due to Clostridium difficile, not specified as recurrent | Use for initial CDI episodes or recurrences beyond 8 weeks. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for recurrent Clostridium difficile infection
Essential facts and insights about Clostridium difficile infection
Primary ICD-10-CM Codes for clostridium difficile infection
Decision Criteria
clinical Criteria
- Patient has had ≥3 episodes of CDI within 8 weeks.
documentation Criteria
- Explicit mention of 'recurrent' in the clinical notes.
Applicable To
- Recurrent Clostridium difficile colitis
Excludes
- Non-recurrent Clostridium difficile infection (A04.72)
Clinical Validation Requirements
- Documentation of 'recurrent' infection
- Positive lab tests (e.g., PCR, toxin EIA) within 8 weeks
Code-Specific Risks
- Misclassification if recurrence timeframe is not documented
Coding Notes
- Ensure recurrence is clearly documented to avoid incorrect coding.
A04.72 - Enterocolitis due to Clostridium difficile, not specified as recurrent
Use for initial CDI episodes or recurrences beyond 8 weeks.
Applicable To
- First-time Clostridium difficile infection
Excludes
- Recurrent Clostridium difficile infection (A04.71)
Clinical Validation Requirements
- Positive lab tests confirming CDI
- Absence of prior CDI within 8 weeks
Coding Notes
Ensure documentation specifies this is not a recurrent case.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to vancomycin
Z16.11Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Clostridium difficile infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.71.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential reimbursement issues.
Mitigation Strategy
Educate clinicians on documentation requirements., Implement EHR prompts for recurrence documentation.
Impact
Reimbursement: Potential for incorrect DRG assignment affecting reimbursement., Compliance: Risk of non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure clinical notes explicitly state the recurrence and timeframe.
Impact
Risk of incorrect coding if recurrence is not documented.
Mitigation Strategy
Implement documentation checks for recurrence timeframe.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Clostridium difficile infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Clostridium difficile infection
Use these documentation templates to ensure complete and accurate documentation for Clostridium difficile infection. These templates include all required elements for proper coding and billing.
Recurrent CDI in a hospitalized patient
Specialty: Infectious DiseaseRequired Elements
- Patient history of CDI
- Current symptoms and stool characteristics
- Lab results confirming CDI
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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