ICD-10 Coding for Clostridium difficile colitis(A04.71, A04.72)
Complete ICD-10-CM coding and documentation guide for Clostridium difficile colitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Clostridium difficile colitis
A04.7-A04.72Primary Range
Enterocolitis due to Clostridium difficile
This range includes codes for both recurrent and non-recurrent C. diff 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 |
|---|---|---|---|
| A04.71 | Enterocolitis due to Clostridium difficile, recurrent | Use for recurrent C. diff infections occurring within 8 weeks of a previous episode. |
|
| A04.72 | Enterocolitis due to Clostridium difficile, non-recurrent | Use for new C. diff infections or those occurring more than 8 weeks after a previous 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 recurrent C. diff colitis
Essential facts and insights about Clostridium difficile colitis
Primary ICD-10-CM Codes for clostridium difficile colitis
Decision Criteria
clinical Criteria
- Recurrent infection within 8 weeks
Applicable To
- Recurrent C. diff infection
Excludes
- Non-recurrent C. diff infection (A04.72)
Clinical Validation Requirements
- Recurrent infection within 8 weeks of a previous episode
- Positive NAAT or EIA test
Code-Specific Risks
- Misclassification if recurrence is not within 8 weeks
Coding Notes
- Ensure documentation specifies recurrence and timeline.
A04.72 - Enterocolitis due to Clostridium difficile, non-recurrent
Use for new C. diff infections or those occurring more than 8 weeks after a previous episode.
Applicable To
- New onset C. diff infection
Excludes
- Recurrent C. diff infection (A04.71)
Clinical Validation Requirements
- New infection or more than 8 weeks since last episode
- Positive NAAT or EIA test
Coding Notes
Ensure documentation specifies non-recurrence and timeline.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Resistance to vancomycin
Z16.11Differential 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 Clostridium difficile colitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.71.
Impact
Clinical: Misclassification of infection severity., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement.
Mitigation Strategy
Verify patient history for previous C. diff episodes, Ensure clear documentation of recurrence
Impact
Reimbursement: Potential underpayment due to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify the timeline of recurrence and use A04.71 if within 8 weeks.
Impact
Incorrect coding of recurrent infections as non-recurrent.
Mitigation Strategy
Implement thorough review of patient history and documentation.
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 Clostridium difficile colitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Clostridium difficile colitis
Use these documentation templates to ensure complete and accurate documentation for Clostridium difficile colitis. These templates include all required elements for proper coding and billing.
Emergency Department Visit for C. diff
Specialty: Emergency MedicineRequired Elements
- Chief complaint
- Stool frequency and consistency
- Previous C. diff history
- Current test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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