ICD-10 Coding for Staph Aureus(B95.62, J15.212)
Complete ICD-10-CM coding and documentation guide for Staph Aureus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Staph Aureus
B95.6-B95.8Primary Range
Bacterial agents as the cause of diseases classified elsewhere
This range includes codes for Staphylococcus aureus as a causal organism in infections.
Bacterial pneumonia, not elsewhere classified
Includes pneumonia due to Staphylococcus aureus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B95.62 | Methicillin-resistant Staphylococcus aureus as the cause of diseases classified elsewhere | Use when MRSA is identified as the causal organism in an infection. |
|
| J15.212 | Pneumonia due to Methicillin-resistant Staphylococcus aureus | Use when MRSA is confirmed as the cause of pneumonia. |
|
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 MRSA
Essential facts and insights about Staph Aureus
Primary ICD-10-CM Codes for staph aureus
Decision Criteria
clinical Criteria
- Confirmed MRSA infection via lab results
documentation Criteria
- Explicit mention of MRSA in clinical notes
Applicable To
- MRSA
Excludes
- MSSA
Clinical Validation Requirements
- MRSA confirmed by culture or PCR
- Antibiotic susceptibility test showing resistance to methicillin
Code-Specific Risks
- Incorrectly using for colonization instead of active infection
Coding Notes
- Ensure documentation specifies MRSA and the site of infection.
J15.212 - Pneumonia due to Methicillin-resistant Staphylococcus aureus
Use when MRSA is confirmed as the cause of pneumonia.
Applicable To
- MRSA pneumonia
Excludes
- Pneumonia due to MSSA
Clinical Validation Requirements
- Positive culture for MRSA from respiratory specimen
- Radiological evidence of pneumonia
Coding Notes
Ensure MRSA is confirmed as the causative agent.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Carrier of methicillin-resistant Staphylococcus aureus
Z22.322Differential 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 Staph Aureus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B95.62.
Impact
Clinical: Potential for incorrect treatment, Regulatory: Non-compliance with coding standards, Financial: Incorrect billing and reimbursement
Mitigation Strategy
Ensure specific organism is documented, Include lab confirmation in notes
Impact
Reimbursement: Incorrect reimbursement due to misclassification, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Use Z22.322 for MRSA colonization without active infection.
Impact
Incorrect coding of MRSA can lead to audit flags.
Mitigation Strategy
Ensure lab confirmation and specific documentation of MRSA.
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 Staph Aureus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Staph Aureus
Use these documentation templates to ensure complete and accurate documentation for Staph Aureus. These templates include all required elements for proper coding and billing.
MRSA infection documentation
Specialty: Infectious DiseaseRequired Elements
- Site of infection
- Confirmation method
- Antibiotic susceptibility
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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