ICD-10 Coding for C. difficile Diarrhea(A04.72, A04.71)
Complete ICD-10-CM coding and documentation guide for C. difficile Diarrhea. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to C. difficile Diarrhea
A04.7-A04.72Primary Range
Enterocolitis due to Clostridioides difficile
This range includes codes for both recurrent and non-recurrent C. difficile infections.
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, non-recurrent | Use for initial episodes of C. difficile infection. |
|
| A04.71 | Enterocolitis due to Clostridioides difficile, recurrent | Use for recurrent episodes occurring 8 weeks or more after resolution of the initial episode. |
|
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 diarrhea
Essential facts and insights about C. difficile Diarrhea
Primary ICD-10-CM Codes for c difficile diarrhea
Decision Criteria
clinical Criteria
- Positive stool test for C. difficile toxin
Applicable To
- Initial episode of C. difficile infection
Excludes
- Recurrent C. difficile infection (A04.71)
Clinical Validation Requirements
- Positive stool culture for C. difficile
- PCR/NAAT positive for toxin B gene
- ≥3 unformed stools in 24 hours
Code-Specific Risks
- Misclassification if recurrence is not specified
Coding Notes
- Ensure documentation specifies non-recurrent nature if applicable.
A04.71 - Enterocolitis due to Clostridioides difficile, recurrent
Use for recurrent episodes occurring 8 weeks or more after resolution of the initial episode.
Applicable To
- Recurrent episode of C. difficile infection
Excludes
- Initial C. difficile infection (A04.72)
Clinical Validation Requirements
- Recurrence ≥8 weeks after resolution of prior episode
- Positive stool culture for C. difficile
Coding Notes
Document the recurrence window accurately.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting C. difficile Diarrhea to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.72.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Specify stool frequency and consistency, Include test results
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure documentation specifies whether the episode is recurrent or non-recurrent.
Impact
Failure to document recurrence accurately can lead to audit issues.
Mitigation Strategy
Ensure clear documentation of recurrence timeline.
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 Diarrhea, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for C. difficile Diarrhea
Use these documentation templates to ensure complete and accurate documentation for C. difficile Diarrhea. These templates include all required elements for proper coding and billing.
Initial C. difficile infection
Specialty: GastroenterologyRequired Elements
- Positive stool test
- Number of stools in 24 hours
- Absence of laxative use
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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