ICD-10 Coding for ESBL Urinary Tract Infection(N39.0, Z16.12, B96.20)
Complete ICD-10-CM coding and documentation guide for ESBL 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 Urinary Tract Infection
N39-N39.9Primary Range
Urinary tract infection, site not specified
Primary range for coding urinary tract infections, including those caused by ESBL-producing organisms.
Resistance to antibiotics
Used to indicate antibiotic resistance, specifically ESBL resistance in this context.
Other bacterial agents as the cause of diseases classified elsewhere
Used to specify the bacterial organism causing the infection, such as E. coli or Klebsiella.
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 diagnosing a urinary tract infection without specifying the site. |
|
| Z16.12 | Resistance to extended spectrum beta-lactamase (ESBL) | Use as a secondary code to indicate ESBL resistance in infections. |
|
| B96.20 | Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere | Use when E. coli is identified as the causative organism in an infection. |
|
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 UTI
Essential facts and insights about ESBL Urinary Tract Infection
Primary ICD-10-CM Codes for esbl 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
- Ensure site is not specified; otherwise, use a more specific code.
Coding Notes
- Always sequence the infection code first, followed by resistance and organism codes.
Z16.12 - Resistance to extended spectrum beta-lactamase (ESBL)
Use as a secondary code to indicate ESBL resistance in infections.
Applicable To
- ESBL resistance
Clinical Validation Requirements
- Laboratory confirmation of ESBL production
- Antibiotic susceptibility testing showing resistance
Coding Notes
Ensure laboratory confirmation of ESBL production is documented.
B96.20 - Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere
Use when E. coli is identified as the causative organism in an infection.
Applicable To
- E. coli as causative organism
Clinical Validation Requirements
- Identification of E. coli in culture
Coding Notes
Ensure organism identification is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to extended spectrum beta-lactamase (ESBL)
Z16.12Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Acute cystitis without hematuria
N30.00Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting ESBL 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 therapy., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Use specific terms like 'ESBL-producing' and document confirmatory tests., Educate clinicians on the importance of detailed documentation.
Impact
Reimbursement: Incorrect sequencing can lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data representation of the patient's condition.
Mitigation Strategy
Always use Z16.12 as a secondary code following the primary infection code.
Impact
Reimbursement: Potential underpayment due to incomplete coding., Compliance: Failure to fully document the infection's etiology., Data Quality: Loss of specificity in clinical data.
Mitigation Strategy
Include B96.20 when E. coli is identified as the causative organism.
Impact
Failure to code ESBL resistance can lead to audit findings.
Mitigation Strategy
Ensure all cases of antibiotic resistance are coded with Z16.12 when applicable.
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 Urinary Tract Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for ESBL Urinary Tract Infection
Use these documentation templates to ensure complete and accurate documentation for ESBL Urinary Tract Infection. These templates include all required elements for proper coding and billing.
Uncomplicated ESBL UTI
Specialty: Primary CareRequired Elements
- Symptoms of UTI
- Urine culture results
- Antibiotic susceptibility testing
- Confirmation of ESBL production
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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