ICD-10 Coding for Vancomycin-Resistant Enterococcus(A49.1, Z06.41, Z22.3)
Complete ICD-10-CM coding and documentation guide for Vancomycin-Resistant Enterococcus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Vancomycin-Resistant Enterococcus
A49-A49.9Primary Range
Bacterial infections of unspecified site
Includes infections due to vancomycin-resistant enterococcus when the specific site is not identified.
Resistance to antibiotics
Used to indicate the presence of antibiotic resistance, such as vancomycin resistance.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A49.1 | Infection due to vancomycin-resistant enterococcus | Use when there is a confirmed infection due to vancomycin-resistant enterococcus. |
|
| Z06.41 | Resistance to vancomycin | Use as a secondary code to indicate antibiotic resistance. |
|
| Z22.3 | Carrier of vancomycin-resistant enterococcus | Use when there is colonization without active infection. |
|
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 vancomycin-resistant enterococcus
Essential facts and insights about Vancomycin-Resistant Enterococcus
Primary ICD-10-CM Codes for vancomycin-resistant enterococcus
Decision Criteria
clinical Criteria
- Positive culture for VRE with clinical signs of infection
Applicable To
- Vancomycin-resistant Enterococcus faecium bacteremia
- Vancomycin-resistant Enterococcus faecalis infection
Excludes
- Colonization without infection (Z22.3)
Clinical Validation Requirements
- Positive blood culture for Enterococcus faecium or faecalis
- Vancomycin MIC ≥32 µg/mL
Code-Specific Risks
- Incorrectly coding colonization as infection
Coding Notes
- Ensure that the infection is confirmed through laboratory testing.
Z06.41 - Resistance to vancomycin
Use as a secondary code to indicate antibiotic resistance.
Applicable To
- Vancomycin resistance confirmed via PCR
Clinical Validation Requirements
- Laboratory confirmation of vancomycin resistance
Coding Notes
Should be used in conjunction with a primary infection code.
Z22.3 - Carrier of vancomycin-resistant enterococcus
Use when there is colonization without active infection.
Applicable To
- Rectal swab positive for VRE colonization
Excludes
- Active infection due to VRE (A49.1)
Clinical Validation Requirements
- Positive surveillance culture without clinical signs of infection
Coding Notes
Ensure no clinical signs of infection are present.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to vancomycin
Z06.41Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Vancomycin-Resistant Enterococcus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A49.1.
Impact
Clinical: May lead to inappropriate antibiotic use., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Always include lab confirmation in documentation, Use templates to ensure completeness
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on antibiotic resistance prevalence.
Mitigation Strategy
Ensure laboratory confirmation of vancomycin resistance is documented.
Impact
Reimbursement: Incorrect billing for infection treatment., Compliance: Violation of coding standards., Data Quality: Misrepresentation of infection rates.
Mitigation Strategy
Use Z22.3 for colonization without active infection.
Impact
Incorrect use of resistance codes without lab confirmation.
Mitigation Strategy
Implement mandatory lab result checks before coding.
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 Vancomycin-Resistant Enterococcus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Vancomycin-Resistant Enterococcus
Use these documentation templates to ensure complete and accurate documentation for Vancomycin-Resistant Enterococcus. These templates include all required elements for proper coding and billing.
VRE Bacteremia
Specialty: Infectious DiseaseRequired Elements
- Positive blood culture
- Vancomycin MIC
- Clinical signs of infection
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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