ICD-10 Coding for Gram-Positive Cocci Infections(A40.0, A41.01, A41.58)
Complete ICD-10-CM coding and documentation guide for Gram-Positive Cocci Infections. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gram-Positive Cocci Infections
A40-A41Primary Range
Sepsis due to Streptococcus and other specified bacteria
This range includes codes for sepsis caused by gram-positive cocci, such as Streptococcus and Staphylococcus species.
Bacterial and viral infectious agents
These codes are used as additional codes to identify the infectious agent in diseases classified elsewhere.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A40.0 | Sepsis due to Streptococcus, group A | Use when blood cultures confirm Streptococcus group A as the causative organism. |
|
| A41.01 | Sepsis due to Methicillin-susceptible Staphylococcus aureus | Use when MSSA is confirmed as the causative organism. |
|
| A41.58 | Sepsis due to other Gram-positive organisms | Use when Gram-positive cocci are identified but not further specified. |
|
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 positive cocci
Essential facts and insights about Gram-Positive Cocci Infections
Primary ICD-10-CM Codes for gram positive cocci
Decision Criteria
clinical Criteria
- Presence of positive blood culture for Streptococcus group A
documentation Criteria
- Documented confirmation of Streptococcus group A
Applicable To
- Sepsis due to Streptococcus pyogenes
Excludes
- Sepsis due to other specified bacteria
Clinical Validation Requirements
- Positive blood culture for Streptococcus group A
- Clinical signs of sepsis
Code-Specific Risks
- Misidentification of the organism can lead to incorrect coding.
Coding Notes
- Ensure the organism is specified in the documentation.
A41.01 - Sepsis due to Methicillin-susceptible Staphylococcus aureus
Use when MSSA is confirmed as the causative organism.
Applicable To
- Sepsis due to MSSA
Excludes
- Sepsis due to MRSA
Clinical Validation Requirements
- Positive blood culture for MSSA
- Clinical signs of sepsis
Coding Notes
Ensure MSSA is specified in the documentation.
A41.58 - Sepsis due to other Gram-positive organisms
Use when Gram-positive cocci are identified but not further specified.
Applicable To
- Sepsis due to unspecified Gram-positive cocci
Excludes
- Sepsis due to specified Gram-positive organisms
Clinical Validation Requirements
- Positive Gram stain showing Gram-positive cocci
- Clinical signs of sepsis
Coding Notes
Ensure documentation supports the presence of Gram-positive cocci.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Streptococcus, group A, as the cause of diseases classified elsewhere
B95.0Methicillin-susceptible Staphylococcus aureus as the cause of diseases classified elsewhere
B95.61Other specified bacterial agents as the cause of diseases classified elsewhere
B95.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Sepsis due to Methicillin-susceptible Staphylococcus aureus
A41.01Sepsis due to Methicillin-resistant Staphylococcus aureus
A41.02Sepsis, unspecified organism
A41.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gram-Positive Cocci Infections to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A40.0.
Impact
Clinical: May lead to inappropriate treatment choices., Regulatory: Non-compliance with coding guidelines., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure lab results are reviewed and documented., Use queries to clarify organism identification.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of clinical data and reporting.
Mitigation Strategy
Query provider for specific organism identification and update code accordingly.
Impact
Failure to document specific organism can lead to audit issues.
Mitigation Strategy
Implement regular documentation audits and provider education.
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-Positive Cocci Infections, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gram-Positive Cocci Infections
Use these documentation templates to ensure complete and accurate documentation for Gram-Positive Cocci Infections. These templates include all required elements for proper coding and billing.
Sepsis with Gram-Positive Cocci
Specialty: Infectious DiseaseRequired Elements
- Positive blood culture results
- Clinical signs of sepsis
- Antibiotic treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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