ICD-10 Coding for Gram-negative Bacteremia(A41.50, B96.4)
Complete ICD-10-CM coding and documentation guide for Gram-negative Bacteremia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gram-negative Bacteremia
A41.5-A41.59Primary Range
Sepsis due to Gram-negative organisms
This range includes codes for sepsis caused by Gram-negative bacteria, which is the primary condition associated with Gram-negative bacteremia.
Other bacterial agents as the cause of diseases classified elsewhere
These codes are used when specific Gram-negative organisms are identified as the cause of conditions classified elsewhere, such as urinary tract infections.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A41.50 | Gram-negative sepsis, unspecified | Use when sepsis is confirmed with Gram-negative bacteremia and the specific organism is not identified. |
|
| B96.4 | Proteus (mirabilis) as the cause of diseases classified elsewhere | Use when Proteus is identified as the cause of a condition classified elsewhere, such as a UTI. |
|
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 gram-negative bacteremia
Essential facts and insights about Gram-negative Bacteremia
Primary ICD-10-CM Codes for gram negative bacteremia
Decision Criteria
clinical Criteria
- Blood cultures confirm Gram-negative organism
documentation Criteria
- Documented evidence of SIRS criteria
Applicable To
- Sepsis due to unspecified Gram-negative organism
Clinical Validation Requirements
- Positive blood cultures for Gram-negative organism
- Presence of systemic inflammatory response syndrome (SIRS) criteria
Code-Specific Risks
- Misclassification if specific organism is identified but not documented
Coding Notes
- Ensure documentation specifies the presence of Gram-negative bacteremia to use this code.
B96.4 - Proteus (mirabilis) as the cause of diseases classified elsewhere
Use when Proteus is identified as the cause of a condition classified elsewhere, such as a UTI.
Applicable To
- Proteus mirabilis infection
Excludes
- Sepsis due to Proteus (A41.51)
Clinical Validation Requirements
- Positive culture for Proteus species
Coding Notes
Ensure linkage to the primary condition code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Bacteremia
R78.81Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gram-negative Bacteremia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A41.50.
Impact
Clinical: Misrepresentation of the specific organism causing sepsis., Regulatory: Non-compliance with coding specificity requirements., Financial: Potential for reduced reimbursement due to incorrect code usage.
Mitigation Strategy
Verify organism identification before coding., Use specific codes for identified Gram-negative organisms.
Impact
Reimbursement: Incorrect principal diagnosis can lead to lower DRG reimbursement., Compliance: Non-compliance with coding guidelines for principal diagnosis., Data Quality: Inaccurate data representation of sepsis cases.
Mitigation Strategy
Use A41.5_ as the primary code for sepsis with Gram-negative bacteremia.
Impact
Failure to document specific organism can lead to audit discrepancies.
Mitigation Strategy
Implement standardized documentation templates that include organism identification.
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 Gram-negative Bacteremia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gram-negative Bacteremia
Use these documentation templates to ensure complete and accurate documentation for Gram-negative Bacteremia. These templates include all required elements for proper coding and billing.
Emergency Department Admission
Specialty: Emergency MedicineRequired Elements
- Source of infection
- Organism identification
- Severity markers
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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