ICD-10 Coding for Enterococcus faecium Infection(B95.2, A41.81, N39.0, T81.4XXA)
Complete ICD-10-CM coding and documentation guide for Enterococcus faecium Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Enterococcus faecium Infection
B95-B97Primary Range
Bacterial and viral infectious agents
Includes codes for identifying the infectious agent in diseases classified elsewhere, such as B95.2 for Enterococcus species.
Other diseases of the urinary system
Includes codes for urinary tract infections, such as N39.0 for UTI.
Complications of surgical and medical care, not elsewhere classified
Includes codes for post-procedural infections, such as T81.4XXA.
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 faecium is confirmed as the causative agent of an infection. |
|
| A41.81 | Sepsis due to Enterococcus | Use when sepsis is confirmed to be due to Enterococcus faecium. |
|
| N39.0 | Urinary tract infection, site not specified | Use for UTIs confirmed to be due to Enterococcus faecium. |
|
| T81.4XXA | Infection following a procedure, initial encounter | Use for infections following procedures confirmed to be due to Enterococcus faecium. |
|
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 faecium
Essential facts and insights about Enterococcus faecium Infection
Primary ICD-10-CM Codes for enterococcus faecium
Decision Criteria
clinical Criteria
- Positive identification of Enterococcus faecium in culture
coding Criteria
- Pair with primary infection code
Applicable To
- Enterococcus faecium
- Enterococcus faecalis
Excludes
- Infections not specified as due to Enterococcus
Clinical Validation Requirements
- Positive culture or PCR identifying Enterococcus faecium
Code-Specific Risks
- Incorrectly using B96.81 for unspecified Enterococcus species.
Coding Notes
- Ensure the infection site is coded as primary, with B95.2 as secondary.
A41.81 - Sepsis due to Enterococcus
Use when sepsis is confirmed to be due to Enterococcus faecium.
Applicable To
- Sepsis due to Enterococcus faecium
Excludes
- Sepsis due to other organisms
Clinical Validation Requirements
- SIRS criteria met
- Positive blood culture for Enterococcus faecium
Coding Notes
Ensure documentation supports sepsis criteria.
N39.0 - Urinary tract infection, site not specified
Use for UTIs confirmed to be due to Enterococcus faecium.
Applicable To
- UTI due to Enterococcus faecium
Excludes
- UTI due to other specified organisms
Clinical Validation Requirements
- Urine culture ≥10^5 CFU/mL
- Symptoms of UTI
Coding Notes
Ensure urine culture results are documented.
T81.4XXA - Infection following a procedure, initial encounter
Use for infections following procedures confirmed to be due to Enterococcus faecium.
Applicable To
- Postoperative wound infection due to Enterococcus faecium
Excludes
- Infections not related to procedures
Clinical Validation Requirements
- Temporal relationship to procedure
- Positive culture for Enterococcus faecium
Coding Notes
Document the procedure and infection onset clearly.
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 Enterococcus faecium Infection 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 antibiotic therapy., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Review lab results for resistance patterns., Ensure resistance is documented in the medical record.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate data on infection causative agents.
Mitigation Strategy
Use B95.2 when the specific species is identified.
Impact
Reimbursement: May affect DRG and reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Incomplete data on antibiotic resistance.
Mitigation Strategy
Include resistance codes when applicable.
Impact
Failure to code resistance can lead to audit findings.
Mitigation Strategy
Implement checks for resistance documentation in lab results.
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 Enterococcus faecium Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Enterococcus faecium Infection
Use these documentation templates to ensure complete and accurate documentation for Enterococcus faecium Infection. These templates include all required elements for proper coding and billing.
Sepsis due to vancomycin-resistant Enterococcus faecium
Specialty: Infectious DiseaseRequired Elements
- Positive blood culture results
- SIRS criteria documentation
- Antibiotic resistance details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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