ICD-10 Coding for Clostridium difficile(A04.71, A04.72)
Complete ICD-10-CM coding and documentation guide for Clostridium difficile. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Clostridium difficile
A04.7-A04.72Primary Range
Enterocolitis due to Clostridium difficile
This range includes codes for enterocolitis due to C. difficile, specifying recurrent and non-recurrent cases.
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 | Recurrent C. difficile enterocolitis | Use when the patient has a recurrent episode of C. difficile infection within 8 weeks of a prior episode. |
|
| A04.72 | Non-recurrent C. difficile enterocolitis | Use for the first occurrence of C. difficile infection or if recurrence is after 8 weeks. |
|
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. difficile
Essential facts and insights about Clostridium difficile
Primary ICD-10-CM Codes for clostridium difficile
Decision Criteria
clinical Criteria
- Recurrent infection within 8 weeks
documentation Criteria
- Lab confirmation of C. difficile toxin
Applicable To
- Recurrent C. difficile infection
Excludes
- Non-recurrent C. difficile enterocolitis (A04.72)
Clinical Validation Requirements
- Positive NAAT for C. difficile toxin B
- ≥3 unformed stools in 24 hours
- History of prior C. difficile infection within 8 weeks
Code-Specific Risks
- Incorrectly coding as non-recurrent
- Lack of documentation for recurrence
Coding Notes
- Ensure documentation specifies recurrence and includes lab confirmation.
A04.72 - Non-recurrent C. difficile enterocolitis
Use for the first occurrence of C. difficile infection or if recurrence is after 8 weeks.
Applicable To
- Initial C. difficile infection
Excludes
- Recurrent C. difficile enterocolitis (A04.71)
Clinical Validation Requirements
- Positive NAAT for C. difficile toxin B
- ≥3 unformed stools in 24 hours
- No prior C. difficile infection within 8 weeks
Coding Notes
Ensure documentation specifies it is the initial occurrence and includes lab confirmation.
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 Clostridium difficile to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.71.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding guidelines., Financial: Potential for incorrect reimbursement.
Mitigation Strategy
Train staff on documentation requirements, Use templates to ensure completeness
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Inaccurate data for surveillance and quality measures.
Mitigation Strategy
Ensure documentation specifies recurrence status and use the appropriate code.
Impact
Failure to document recurrence can lead to incorrect coding.
Mitigation Strategy
Implement documentation templates and staff training.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Clostridium difficile
Use these documentation templates to ensure complete and accurate documentation for Clostridium difficile. These templates include all required elements for proper coding and billing.
Recurrent C. difficile infection
Specialty: GastroenterologyRequired Elements
- Stool frequency and consistency
- Lab results
- Prior history of C. diff
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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