Back to HomeBeta

ICD-10 Coding for ESBL Infections(Z16.12, A41.5, N39.0)

Complete ICD-10-CM coding and documentation guide for ESBL Infections. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Extended-Spectrum Beta-Lactamase InfectionsESBL-producing Bacterial Infections

Related ICD-10 Code Ranges

Complete code families applicable to ESBL Infections

Z16-Z16.9Primary Range

Resistance to antimicrobial drugs

This range includes codes for resistance to antimicrobial drugs, specifically Z16.12 for ESBL resistance.

Sepsis

Includes codes for sepsis, which may be used when ESBL leads to septicemia.

Urinary tract infection, site not specified

Used for coding urinary tract infections, which can be caused by ESBL-producing organisms.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
Z16.12Resistance to extended-spectrum beta-lactamase (ESBL)Use when ESBL resistance is confirmed by lab tests and documented in the patient's record.
  • Lab confirmation of ESBL resistance
  • Documentation of specific organism
A41.5Sepsis due to Gram-negative organismUse when sepsis is confirmed and linked to an ESBL-producing organism.
  • Blood culture confirming Gram-negative organism
  • Clinical signs of sepsis
N39.0Urinary tract infection, site not specifiedUse for UTIs confirmed to be caused by ESBL-producing organisms.
  • Urine culture confirming ESBL-producing organism

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 resistance

Essential facts and insights about ESBL Infections

The ICD-10 code for ESBL resistance is Z16.12, indicating resistance to extended-spectrum beta-lactamase.

Primary ICD-10-CM Codes for esbl

Resistance to extended-spectrum beta-lactamase (ESBL)
Billable Code

Decision Criteria

clinical Criteria

  • ESBL resistance confirmed by lab tests

documentation Criteria

  • Specific organism and resistance pattern documented

Applicable To

  • ESBL resistance confirmed by lab

Excludes

  • Carrier status without active infection

Clinical Validation Requirements

  • Lab confirmation of ESBL resistance
  • Documentation of specific organism

Code-Specific Risks

  • Incorrect sequencing with primary infection codes

Coding Notes

  • Ensure ESBL resistance is documented in the lab report and clinical notes.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

ESBL-producing organism (AU specific)

U93
Use with Z14-Z15 codes for ESBL-producing organisms.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Carrier of infectious disease

Z22.3
Use Z22.3 for carrier status without active infection.

Sepsis, unspecified organism

A41.9
Use A41.9 when the organism is not specified.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting ESBL Infections to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z16.12.

Impact

Clinical: Leads to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential claim rejections.

Mitigation Strategy

Always document the specific organism., Review lab reports before coding.

Impact

Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data on antimicrobial resistance.

Mitigation Strategy

Always sequence Z16.12 after the primary infection code.

Impact

Incorrect coding of antimicrobial resistance can lead to audits.

Mitigation Strategy

Ensure all resistance is lab-confirmed and documented.

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 Infections, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for ESBL Infections

Use these documentation templates to ensure complete and accurate documentation for ESBL Infections. These templates include all required elements for proper coding and billing.

ESBL UTI in outpatient setting

Specialty: Urology

Required Elements

  • Organism name
  • Resistance confirmation method
  • Clinical impact

Example Documentation

Patient diagnosed with ESBL-producing E. coli UTI confirmed by VITEK®2 ESBL panel.

Examples: Poor vs. Good Documentation

Poor Documentation Example
UTI with resistant bacteria.
Good Documentation Example
ESBL-producing E. coli UTI confirmed by VITEK®2 ESBL panel.
Explanation
The good example specifies the organism and confirmation method.

Need help with ICD-10 coding for ESBL Infections? Ask your questions below.

Ask about any ICD-10 CM code, or paste a medical note

We build tools for
clinician happiness.

Learn More at Freed.ai
Back to HomeBeta

Built by Freed

Try Freed for free for 7 days.

Learn more