ICD-10 Coding for Enterocolitis(A04.7, A04.71, A04.72, P77.9)
Complete ICD-10-CM coding and documentation guide for Enterocolitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Enterocolitis
A04.7-A04.72Primary Range
Bacterial enterocolitis due to Clostridium difficile
This range covers enterocolitis caused by C. difficile, including recurrent and non-recurrent cases.
Necrotizing enterocolitis in newborns
This code is used for necrotizing enterocolitis in neonates, a severe condition often seen in premature infants.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A04.7 | Enterocolitis due to Clostridium difficile | Use when C. difficile is confirmed as the cause of enterocolitis. |
|
| A04.71 | Recurrent enterocolitis due to Clostridium difficile | Use for recurrent cases of C. difficile enterocolitis. |
|
| A04.72 | Enterocolitis due to Clostridium difficile, not specified as recurrent | Use for initial episodes not specified as recurrent. |
|
| P77.9 | Necrotizing enterocolitis in newborn | Use for NEC in premature infants. |
|
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 enterocolitis
Essential facts and insights about Enterocolitis
Primary ICD-10-CM Codes for enterocolitis
Decision Criteria
clinical Criteria
- Presence of pseudomembranes on endoscopy
Applicable To
- C. difficile colitis
- Pseudomembranous colitis
Excludes
- Carrier state of C. difficile (Z22.3)
Clinical Validation Requirements
- Stool PCR positive for C. difficile toxin
- Colonic wall thickening on CT
Code-Specific Risks
- Misclassification if not confirmed by lab tests
Coding Notes
- Ensure lab confirmation of C. difficile presence.
A04.71 - Recurrent enterocolitis due to Clostridium difficile
Use for recurrent cases of C. difficile enterocolitis.
Applicable To
- Recurrent C. difficile colitis
Clinical Validation Requirements
- Documented recurrence within 8 weeks
- Failure of initial treatment
Coding Notes
Ensure documentation specifies recurrence.
A04.72 - Enterocolitis due to Clostridium difficile, not specified as recurrent
Use for initial episodes not specified as recurrent.
Clinical Validation Requirements
- Initial episode with positive stool test for C. difficile
Coding Notes
Ensure no documentation of recurrence.
P77.9 - Necrotizing enterocolitis in newborn
Use for NEC in premature infants.
Applicable To
- NEC in neonates
Clinical Validation Requirements
- Prematurity and characteristic X-ray findings
Coding Notes
Document gestational age and clinical findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified Escherichia coli as the cause of diseases classified elsewhere
B96.20Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Enterocolitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A04.7.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure lab results are included in patient records., Use templates to guide documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies recurrence if present and use A04.71.
Impact
High risk of audit if recurrence is not documented.
Mitigation Strategy
Ensure detailed documentation of recurrence and treatment history.
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 Enterocolitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Enterocolitis
Use these documentation templates to ensure complete and accurate documentation for Enterocolitis. These templates include all required elements for proper coding and billing.
Recurrent C. difficile enterocolitis
Specialty: GastroenterologyRequired Elements
- Recurrence documentation
- Lab confirmation
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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