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:
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.
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
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z16.12 | Resistance to extended-spectrum beta-lactamase (ESBL) | Use when ESBL resistance is confirmed by lab tests and documented in the patient's record. |
|
| A41.5 | Sepsis due to Gram-negative organism | Use when sepsis is confirmed and linked to an ESBL-producing organism. |
|
| N39.0 | Urinary tract infection, site not specified | Use for UTIs confirmed to be caused by ESBL-producing organisms. |
|
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
Primary ICD-10-CM Codes for esbl
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.
A41.5 - Sepsis due to Gram-negative organism
Use when sepsis is confirmed and linked to an ESBL-producing organism.
Applicable To
- Sepsis with ESBL resistance
Excludes
- Sepsis without specified organism
Clinical Validation Requirements
- Blood culture confirming Gram-negative organism
- Clinical signs of sepsis
Coding Notes
Ensure sepsis is documented with clinical indicators and lab confirmation.
N39.0 - Urinary tract infection, site not specified
Use for UTIs confirmed to be caused by ESBL-producing organisms.
Applicable To
- UTI due to ESBL-producing organism
Excludes
- UTI with specified site
Clinical Validation Requirements
- Urine culture confirming ESBL-producing organism
Coding Notes
Ensure UTI is documented with lab confirmation of ESBL organism.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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: UrologyRequired Elements
- Organism name
- Resistance confirmation method
- Clinical impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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