ICD-10 Coding for Enterococcus Infection(B95.2, A41.81)
Complete ICD-10-CM coding and documentation guide for Enterococcus Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Enterococcus Infection
B95-B96Primary Range
Bacterial agents as the cause of diseases classified elsewhere
This range includes codes for bacterial agents like Enterococcus that cause infections classified under other conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B95.2 | Enterococcus as the cause of diseases classified elsewhere | Use when Enterococcus is identified as the causative organism for a condition classified elsewhere, such as UTI or pneumonia. |
|
| A41.81 | Sepsis due to Enterococcus | Use when sepsis is confirmed to be due to Enterococcus species. |
|
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 Enterococcus
Essential facts and insights about Enterococcus Infection
Primary ICD-10-CM Codes for enterococcus
Decision Criteria
clinical Criteria
- Enterococcus identified in culture with clinical signs of infection
coding Criteria
- Primary condition code does not specify Enterococcus
Applicable To
- Enterococcus infection
- Enterococcus bacteremia
Excludes
- Sepsis due to Enterococcus (A41.81)
Clinical Validation Requirements
- Positive culture for Enterococcus from a sterile site
- Clinical signs of infection such as fever, elevated WBC
Code-Specific Risks
- Incorrectly using B96.81 instead of B95.2 for Enterococcus
Coding Notes
- Ensure the primary condition code is sequenced before B95.2.
A41.81 - Sepsis due to Enterococcus
Use when sepsis is confirmed to be due to Enterococcus species.
Applicable To
- Sepsis due to Enterococcus faecalis
- Sepsis due to Enterococcus faecium
Clinical Validation Requirements
- Positive blood cultures for Enterococcus
- Systemic inflammatory response syndrome (SIRS) criteria met
Coding Notes
Do not use B95.2 with A41.81 as the organism is already specified.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to vancomycin
Z16.21Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Enterococcus Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B95.2.
Impact
Clinical: Inadequate treatment planning., Regulatory: Failure to comply with coding guidelines., Financial: Potential loss of reimbursement for resistant infections.
Mitigation Strategy
Review lab results for resistance patterns., Ensure resistance is documented in the medical record.
Impact
Reimbursement: Incorrect coding may lead to denied claims or reduced reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Use B95.2 for Enterococcus as it is specifically listed under this code.
Impact
Using B96.81 instead of B95.2 for Enterococcus.
Mitigation Strategy
Educate coders on the specific use of B95.2 for Enterococcus.
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 Enterococcus Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Enterococcus Infection
Use these documentation templates to ensure complete and accurate documentation for Enterococcus Infection. These templates include all required elements for proper coding and billing.
Enterococcus bacteremia
Specialty: Infectious DiseaseRequired Elements
- Positive blood culture results
- Clinical signs of infection
- Antibiotic susceptibility results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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