ICD-10 Coding for C. diff Colitis(A04.7, A04.71, A04.72)
Complete ICD-10-CM coding and documentation guide for C. diff Colitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to C. diff Colitis
A00-A09Primary Range
Intestinal infectious diseases
This range includes codes for infectious diseases of the intestines, including C. diff colitis.
Other and unspecified noninfective gastroenteritis and colitis
This range includes noninfectious colitis, which may be relevant for differential diagnosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A04.7 | Enterocolitis due to Clostridium difficile | Use when C. diff colitis is confirmed by lab tests and clinical symptoms. |
|
| A04.71 | Enterocolitis due to Clostridium difficile, recurrent | Use when there is a documented recurrence of C. diff colitis. |
|
| A04.72 | Enterocolitis due to Clostridium difficile, not specified as recurrent | Use when recurrence status is not 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 C. diff colitis
Essential facts and insights about C. diff Colitis
Primary ICD-10-CM Codes for c diff colitis
Decision Criteria
clinical Criteria
- Presence of diarrhea and positive toxin test
coding Criteria
- Avoid using A04.7 if only PCR is positive without symptoms
Applicable To
- Acute C. diff colitis
Excludes
- Noninfectious colitis (K52.89)
Clinical Validation Requirements
- Positive toxin assay or PCR
- Documentation of diarrhea (≥3 unformed stools/24hr)
Code-Specific Risks
- Coding based solely on lab results without clinical correlation
Coding Notes
- Ensure provider documentation links symptoms to C. diff.
A04.71 - Enterocolitis due to Clostridium difficile, recurrent
Use when there is a documented recurrence of C. diff colitis.
Applicable To
- Recurrent C. diff colitis
Clinical Validation Requirements
- Documentation of recurrence within 8 weeks of prior episode
Coding Notes
Ensure recurrence is clearly documented.
A04.72 - Enterocolitis due to Clostridium difficile, not specified as recurrent
Use when recurrence status is not specified.
Applicable To
- Initial or unspecified recurrence status
Clinical Validation Requirements
- Positive toxin assay or PCR without recurrence documentation
Coding Notes
Use when documentation does not specify recurrence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to other specified antimicrobial drugs
Z16.39Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other specified noninfective gastroenteritis and colitis
K52.89Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting C. diff Colitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.7.
Impact
Clinical: Misrepresents patient condition, Regulatory: Non-compliance with coding standards, Financial: Incorrect billing and reimbursement
Mitigation Strategy
Verify symptoms before coding, Consult provider if unclear
Impact
Reimbursement: May lead to incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Ensure clinical symptoms are documented alongside positive PCR.
Impact
Reimbursement: Incorrect DRG and reimbursement, Compliance: Potential audit risk, Data Quality: Misleading recurrence data
Mitigation Strategy
Query provider for recurrence details if not documented.
Impact
Failure to document recurrence can lead to audit issues.
Mitigation Strategy
Ensure clear documentation of recurrence and prior treatment.
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 C. diff Colitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for C. diff Colitis
Use these documentation templates to ensure complete and accurate documentation for C. diff Colitis. These templates include all required elements for proper coding and billing.
Recurrent C. diff colitis
Specialty: GastroenterologyRequired Elements
- Symptom onset and duration
- Previous treatment details
- Current lab results
- Recurrence documentation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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