ICD-10 Coding for Enterococcal Bacteremia(B95.2, A41.81, R78.81)
Complete ICD-10-CM coding and documentation guide for Enterococcal Bacteremia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Enterococcal Bacteremia
B95-B97Primary Range
Bacterial and viral infectious agents
This range includes codes for bacterial agents as the cause of diseases classified elsewhere, including Enterococcus.
Sepsis
This range includes codes for sepsis, which may be used when Enterococcus causes sepsis.
Findings of drugs and other substances, not normally found in blood
This range includes codes for bacteremia, which may be used when Enterococcus is identified in the blood without a specified source.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B95.2 | Enterococcus as the cause of diseases classified elsewhere | Use when Enterococcus is identified as the cause of an infection classified elsewhere. |
|
| A41.81 | Sepsis due to Enterococcus | Use when sepsis is confirmed with Enterococcus as the causative organism. |
|
| R78.81 | Bacteremia | Use when bacteremia is confirmed without a specified source. |
|
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 Enterococcus bacteremia
Essential facts and insights about Enterococcal Bacteremia
Primary ICD-10-CM Codes for enterococcus bacteremia
Decision Criteria
clinical Criteria
- Positive blood cultures for Enterococcus
documentation Criteria
- Specify the site of infection caused by Enterococcus
Applicable To
- Enterococcus faecalis
- Enterococcus faecium
Excludes
- Sepsis due to Enterococcus (A41.81)
Clinical Validation Requirements
- Positive blood culture for Enterococcus
- Documented infection site
Code-Specific Risks
- Cannot be used as a principal diagnosis
Coding Notes
- Ensure the source of infection is documented to support coding.
A41.81 - Sepsis due to Enterococcus
Use when sepsis is confirmed with Enterococcus as the causative organism.
Applicable To
- Septicemia due to Enterococcus
Excludes
- Bacteremia without sepsis (R78.81)
Clinical Validation Requirements
- SIRS criteria met
- Positive blood culture for Enterococcus
Coding Notes
Ensure documentation of sepsis criteria and organism identification.
R78.81 - Bacteremia
Use when bacteremia is confirmed without a specified source.
Applicable To
- Presence of bacteria in blood
Excludes
- Sepsis (A41.9)
Clinical Validation Requirements
- Positive blood culture
- No identified source after 48 hours
Coding Notes
Ensure no other source of infection is identified before using this code.
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 Enterococcal Bacteremia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B95.2.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denial due to incomplete coding.
Mitigation Strategy
Always document culture results., Specify organism in clinical notes.
Impact
Reimbursement: Incorrect sequencing can lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always sequence the underlying condition first.
Impact
Reimbursement: Missing resistance coding can affect DRG assignment., Compliance: Failure to document resistance violates coding standards., Data Quality: Incomplete resistance data affects treatment decisions.
Mitigation Strategy
Include Z16.21 and specify the MIC value.
Impact
Incorrect sequencing of sepsis and causative organism.
Mitigation Strategy
Ensure sepsis criteria are documented and sequence codes correctly.
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 Enterococcal Bacteremia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Enterococcal Bacteremia
Use these documentation templates to ensure complete and accurate documentation for Enterococcal Bacteremia. These templates include all required elements for proper coding and billing.
Enterococcal bacteremia with UTI
Specialty: Infectious DiseaseRequired Elements
- Positive blood culture for Enterococcus
- Positive urine culture
- Symptoms of UTI
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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