ICD-10 Coding for C. difficile colitis(A04.72, A04.71)
Complete ICD-10-CM coding and documentation guide for C. difficile colitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to C. difficile colitis
A04.7Primary Range
Enterocolitis due to Clostridioides difficile
Primary range for coding C. difficile infections, including recurrent and non-recurrent cases.
Toxic gastroenteritis and colitis
Used if C. difficile is ruled out but pseudomembranous colitis is present.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A04.72 | Enterocolitis due to Clostridioides difficile, not specified as recurrent | Use for initial or first-time episodes of C. difficile colitis. |
|
| A04.71 | Enterocolitis due to Clostridioides difficile, recurrent | Use for recurrent episodes within 8 weeks of resolution. |
|
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. difficile colitis
Essential facts and insights about C. difficile colitis
Primary ICD-10-CM Codes for c difficile colitis
Decision Criteria
clinical Criteria
- New onset diarrhea with positive NAAT/toxin test, no prior CDI in past 8 weeks
Applicable To
- Initial or first-time episodes of C. difficile colitis
Excludes
- Recurrent C. difficile colitis (A04.71)
Clinical Validation Requirements
- ≥3 unformed stools (Bristol Stool Scale 5–7) in 24 hours
- Positive toxin EIA/NAAT/culture for toxigenic C. difficile
- No alternative explanation for diarrhea
Code-Specific Risks
- Misclassification as recurrent if not properly documented.
Coding Notes
- Ensure documentation specifies the episode as initial or first-time.
A04.71 - Enterocolitis due to Clostridioides difficile, recurrent
Use for recurrent episodes within 8 weeks of resolution.
Applicable To
- Recurrent episodes of C. difficile colitis within 8 weeks
Excludes
- Initial or first-time episodes of C. difficile colitis (A04.72)
Clinical Validation Requirements
- Recurrent CDI confirmed within 8 weeks of prior resolved episode
- Positive toxin EIA/NAAT/culture for toxigenic C. difficile
Coding Notes
Ensure documentation specifies the episode as recurrent.
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. difficile colitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.72.
Impact
Clinical: Misdiagnosis of recurrent vs. initial infection., Regulatory: Non-compliance with coding standards., Financial: Incorrect billing and potential revenue loss.
Mitigation Strategy
Use templates that prompt for recurrence details., Educate clinicians on documentation requirements.
Impact
Reimbursement: Incorrect reimbursement due to misclassification., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data and statistics.
Mitigation Strategy
Query provider to clarify if the CDI episode is within 8 weeks of prior resolved infection.
Impact
Reimbursement: Potential underpayment due to incorrect coding., Compliance: Failure to comply with coding standards., Data Quality: Misleading data on infection rates.
Mitigation Strategy
Link diarrhea explicitly to C. difficile in documentation.
Impact
Risk of incorrect coding if recurrence is not documented.
Mitigation Strategy
Implement documentation checks for recurrence timelines.
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. difficile colitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for C. difficile colitis
Use these documentation templates to ensure complete and accurate documentation for C. difficile colitis. These templates include all required elements for proper coding and billing.
Recurrent C. difficile colitis
Specialty: GastroenterologyRequired Elements
- Number of stools and consistency
- Positive toxin EIA/NAAT/culture results
- Recurrence timeline
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for C. difficile colitis? Ask your questions below.