ICD-10 Coding for ESBL-producing E. coli Urinary Tract Infection(N39.0, B96.20, Z16.12, A41.51)
Complete ICD-10-CM coding and documentation guide for ESBL-producing E. coli Urinary Tract Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to ESBL-producing E. coli Urinary Tract Infection
N39.0Primary Range
Urinary tract infection, site not specified
Primary code for unspecified site UTI, often used when the specific site is not documented.
Unspecified Escherichia coli as the cause of diseases classified elsewhere
Used to specify E. coli as the causative organism in infections.
Resistance to extended spectrum beta-lactam antibiotics
Indicates resistance due to ESBL production, used with infection codes.
Sepsis due to Escherichia coli
Primary code for sepsis due to E. coli, used when sepsis is present.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N39.0 | Urinary tract infection, site not specified | Use when the site of the UTI is not specified in the documentation. |
|
| B96.20 | Unspecified Escherichia coli as the cause of diseases classified elsewhere | Use to specify E. coli as the causative organism in a UTI. |
|
| Z16.12 | Resistance to extended spectrum beta-lactam antibiotics | Use when ESBL resistance is confirmed in the infection. |
|
| A41.51 | Sepsis due to Escherichia coli | Use when sepsis is documented as due to E. coli. |
|
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 ESBL E. coli UTI
Essential facts and insights about ESBL-producing E. coli Urinary Tract Infection
Primary ICD-10-CM Codes for esbl physician initial coli urinary tract infection
Decision Criteria
clinical Criteria
- Presence of UTI symptoms and positive urine culture
Clinical Validation Requirements
- Symptoms of UTI such as dysuria, frequency, urgency
- Positive urine culture
Code-Specific Risks
- May lead to under-coding if specific site is documented but not coded.
Coding Notes
- Ensure documentation specifies UTI and causative organism for accurate coding.
B96.20 - Unspecified Escherichia coli as the cause of diseases classified elsewhere
Use to specify E. coli as the causative organism in a UTI.
Applicable To
- E. coli infection
Excludes
- Sepsis due to E. coli (A41.51)
Clinical Validation Requirements
- Positive culture identifying E. coli
Coding Notes
Ensure E. coli is documented as the causative organism.
Z16.12 - Resistance to extended spectrum beta-lactam antibiotics
Use when ESBL resistance is confirmed in the infection.
Applicable To
- ESBL resistance
Clinical Validation Requirements
- Antimicrobial susceptibility testing confirming ESBL production
Coding Notes
Ensure ESBL resistance is documented and confirmed by lab tests.
A41.51 - Sepsis due to Escherichia coli
Use when sepsis is documented as due to E. coli.
Applicable To
- E. coli sepsis
Clinical Validation Requirements
- Clinical signs of sepsis and positive blood culture for E. coli
Coding Notes
Ensure sepsis due to E. coli is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to extended spectrum beta-lactam antibiotics
Z16.12Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Acute cystitis
N30.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting ESBL-producing E. coli Urinary Tract Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N39.0.
Impact
Clinical: May lead to inappropriate antibiotic selection., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement for complex cases.
Mitigation Strategy
Ensure lab results are reviewed and documented., Educate providers on the importance of resistance documentation.
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Redundant data entry.
Mitigation Strategy
Omit B96.20 when A41.51 is used.
Impact
Reimbursement: Potential underpayment due to missing complexity., Compliance: Incomplete coding of resistance., Data Quality: Inaccurate representation of resistance patterns.
Mitigation Strategy
Add Z16.12 for antimicrobial resistance.
Impact
Failure to code ESBL resistance can lead to audit findings.
Mitigation Strategy
Implement regular training and audits to ensure compliance.
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 ESBL-producing E. coli Urinary Tract Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for ESBL-producing E. coli Urinary Tract Infection
Use these documentation templates to ensure complete and accurate documentation for ESBL-producing E. coli Urinary Tract Infection. These templates include all required elements for proper coding and billing.
Uncomplicated ESBL E. coli cystitis
Specialty: UrologyRequired Elements
- Symptoms of UTI
- Positive urine culture
- ESBL resistance confirmation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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