ICD-10 Coding for C. diff Infection(A04.71, A04.72, A48.8)
Complete ICD-10-CM coding and documentation guide for C. diff Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to C. diff Infection
A04.7Primary Range
Other specified bacterial intestinal infections
This range includes codes for C. diff infections, specifically recurrent and non-recurrent enterocolitis.
Other specified bacterial diseases
Used for C. diff infections outside the gastrointestinal tract, such as bacteremia or sepsis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A04.71 | Enterocolitis due to Clostridioides difficile, recurrent | Use when the patient has a documented recurrent C. diff infection within 8 weeks of a previous episode. |
|
| A04.72 | Enterocolitis due to Clostridioides difficile, non-recurrent | Use for initial or non-recurrent C. diff infections. |
|
| A48.8 | Other specified bacterial diseases | Use for C. diff infections not involving the gastrointestinal tract. |
|
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 recurrent C. diff infection
Essential facts and insights about C. diff Infection
Primary ICD-10-CM Codes for c diff infection
Decision Criteria
clinical Criteria
- Recurrent symptoms and positive lab test within 8 weeks
Applicable To
- Recurrent C. diff infection
- Recurrent pseudomembranous colitis
Excludes
- Non-recurrent C. diff infection (A04.72)
Clinical Validation Requirements
- Positive stool toxin assay or PCR within 8 weeks of prior episode
- Documentation of recurrent symptoms such as diarrhea
Code-Specific Risks
- Incorrectly coding as non-recurrent when recurrence is documented.
Coding Notes
- Ensure documentation specifies recurrence and positive lab results.
A04.72 - Enterocolitis due to Clostridioides difficile, non-recurrent
Use for initial or non-recurrent C. diff infections.
Applicable To
- Initial C. diff infection
- Non-recurrent pseudomembranous colitis
Excludes
- Recurrent C. diff infection (A04.71)
Clinical Validation Requirements
- Positive stool toxin assay or PCR
- No documented recurrence within 8 weeks
Coding Notes
Ensure documentation specifies non-recurrence and positive lab results.
A48.8 - Other specified bacterial diseases
Use for C. diff infections not involving the gastrointestinal tract.
Applicable To
- C. diff infections outside the GI tract
Excludes
- Enterocolitis due to C. diff (A04.71, A04.72)
Clinical Validation Requirements
- Positive lab results indicating C. diff outside the GI tract
Coding Notes
Ensure documentation specifies the site of infection.
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 C. diff Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.71.
Impact
Clinical: Potential misdiagnosis or delayed treatment., Regulatory: Non-compliance with documentation standards., Financial: Denial of claims due to insufficient documentation.
Mitigation Strategy
Ensure detailed symptom documentation, Include lab results and treatment plans
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify recurrence status and use A04.71 if within 8 weeks.
Impact
Reimbursement: Potential denial of sepsis-related claims., Compliance: Failure to meet coding standards., Data Quality: Misrepresentation of infection source.
Mitigation Strategy
Ensure documentation links sepsis to C. diff.
Impact
Incorrect coding of recurrent infections as non-recurrent.
Mitigation Strategy
Verify recurrence status and document appropriately.
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 Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for C. diff Infection
Use these documentation templates to ensure complete and accurate documentation for C. diff Infection. These templates include all required elements for proper coding and billing.
Hospital Admission for C. diff
Specialty: Infectious DiseaseRequired Elements
- Patient history of diarrhea
- Lab results confirming C. diff
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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