ICD-10 Coding for Verotoxin(B96.21, A04.3, D59.3)
Complete ICD-10-CM coding and documentation guide for Verotoxin. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Verotoxin
B96.2-B96.29Primary Range
Escherichia coli as the cause of diseases classified elsewhere
This range includes codes for infections caused by Shiga toxin-producing E. coli, including specific serotypes like O157.
Enterocolitis due to Shiga toxin-producing Escherichia coli
This code is used when gastrointestinal symptoms are the primary manifestation of the infection.
Hemolytic-uremic syndrome
This code is used when hemolytic-uremic syndrome is the primary manifestation of the infection.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B96.21 | Shiga toxin-producing Escherichia coli [STEC] O157 | Use when STEC O157 is confirmed and linked to clinical manifestations. |
|
| A04.3 | Enterocolitis due to Shiga toxin-producing Escherichia coli | Use when gastrointestinal symptoms are the primary manifestation. |
|
| D59.3 | Hemolytic-uremic syndrome | Use when HUS is the primary manifestation. |
|
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 verotoxin
Essential facts and insights about Verotoxin
Primary ICD-10-CM Codes for verotoxin
Decision Criteria
clinical Criteria
- Confirmed O157 serotype with clinical symptoms.
documentation Criteria
- Lab results specifying O157 serotype.
Applicable To
- STEC O157:H7
Excludes
- Non-O157 STEC infections
Clinical Validation Requirements
- Confirmation of O157 serotype via PCR or culture
- Presence of Shiga toxin genes (stx1/stx2)
Code-Specific Risks
- Incorrectly using this code without serotype confirmation.
Coding Notes
- Ensure lab confirmation of serotype before coding.
A04.3 - Enterocolitis due to Shiga toxin-producing Escherichia coli
Use when gastrointestinal symptoms are the primary manifestation.
Applicable To
- Gastroenteritis due to STEC
Excludes
- HUS without enterocolitis
Clinical Validation Requirements
- Presence of gastrointestinal symptoms
- Lab confirmation of STEC
Coding Notes
Ensure documentation of gastrointestinal symptoms.
D59.3 - Hemolytic-uremic syndrome
Use when HUS is the primary manifestation.
Applicable To
- HUS secondary to STEC
Excludes
- HUS not related to STEC
Clinical Validation Requirements
- Presence of HUS symptoms
- Lab confirmation of STEC
Coding Notes
Ensure documentation of HUS symptoms and STEC confirmation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Verotoxin to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B96.21.
Impact
Clinical: May lead to incorrect treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Always confirm serotype with lab tests., Include specific serotype in documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure lab confirmation of O157 serotype before coding.
Impact
Reimbursement: Potential underpayment for services rendered., Compliance: Failure to follow coding guidelines., Data Quality: Incomplete clinical data capture.
Mitigation Strategy
Always pair A04.3 with B96.21 for confirmed STEC.
Impact
Coding O157 without lab confirmation.
Mitigation Strategy
Require lab confirmation 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 Verotoxin, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Verotoxin
Use these documentation templates to ensure complete and accurate documentation for Verotoxin. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Suspected STEC
Specialty: Emergency MedicineRequired Elements
- Chief complaint
- History of present illness
- Lab results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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