ICD-10 Coding for Acute Urinary Tract Infection(N30.00, N10)
Complete ICD-10-CM coding and documentation guide for Acute Urinary Tract Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acute Urinary Tract Infection
N30-N39Primary Range
Diseases of the urinary system
This range includes codes for various urinary tract infections, including acute cystitis and pyelonephritis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N30.00 | Acute cystitis without hematuria | Use when the patient presents with symptoms of acute cystitis without hematuria. |
|
| N10 | Acute pyelonephritis | Use when the patient has symptoms indicative of kidney 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 acute urinary tract infection
Essential facts and insights about Acute Urinary Tract Infection
Primary ICD-10-CM Codes for acute urinary tract infection
Decision Criteria
clinical Criteria
- Patient presents with dysuria and suprapubic pain.
documentation Criteria
- Documentation must specify 'acute cystitis' without hematuria.
Applicable To
- Acute bladder infection
Excludes
- Chronic cystitis (N30.2)
Clinical Validation Requirements
- Dysuria
- Suprapubic pain
- Negative imaging for upper UTI
Code-Specific Risks
- Misclassification if hematuria is present but not documented.
Coding Notes
- Ensure documentation specifies 'acute' and absence of hematuria.
N10 - Acute pyelonephritis
Use when the patient has symptoms indicative of kidney infection.
Applicable To
- Acute infection of the kidney
Excludes
- Chronic pyelonephritis (N11.0)
Clinical Validation Requirements
- Flank pain
- Fever >38°C
- WBC casts on urinalysis
Coding Notes
Document specific symptoms like flank pain and fever.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere
B96.20Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acute Urinary Tract Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N30.00.
Impact
Clinical: May lead to inappropriate antibiotic selection., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always include culture results in documentation., Use specific organism codes when available.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Document 'sepsis due to E. coli UTI' to ensure proper coding.
Impact
Failure to document linkage can lead to audit flags.
Mitigation Strategy
Use specific phrases like 'sepsis due to UTI'.
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 Acute Urinary Tract Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acute Urinary Tract Infection
Use these documentation templates to ensure complete and accurate documentation for Acute Urinary Tract Infection. These templates include all required elements for proper coding and billing.
Emergency Department Note for Acute Cystitis
Specialty: Emergency MedicineRequired Elements
- Chief Complaint
- History of Present Illness
- Physical Exam
- Laboratory Results
- Assessment and Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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