ICD-10 Coding for Group B Streptococcus(A40.1, B95.1, Z22.330)
Complete ICD-10-CM coding and documentation guide for Group B Streptococcus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Group B Streptococcus
A40-A41Primary Range
Sepsis due to streptococcus and other specified organisms
Includes sepsis caused by Group B Streptococcus, which is a common cause of neonatal sepsis and infections in pregnant women.
Streptococcus and staphylococcus as the cause of diseases classified elsewhere
Used as an additional code to identify the infectious agent in diseases classified elsewhere.
Carrier of infectious diseases
Used to indicate carrier status of Group B Streptococcus without active infection.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A40.1 | Sepsis due to streptococcus, group B | Use when there is confirmed sepsis due to Group B Streptococcus. |
|
| B95.1 | Streptococcus, group B, as the cause of diseases classified elsewhere | Use as a secondary code to specify the organism in infections classified elsewhere. |
|
| Z22.330 | Carrier of Group B streptococcus | Use for asymptomatic carriers, especially in pregnancy. |
|
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 Group B Streptococcus sepsis
Essential facts and insights about Group B Streptococcus
Primary ICD-10-CM Codes for group b streptococcus
Decision Criteria
clinical Criteria
- Confirmed sepsis with positive GBS blood culture.
documentation Criteria
- Documented systemic infection symptoms and positive culture.
Applicable To
- Sepsis due to Group B Streptococcus
Excludes
- Neonatal sepsis (P36.0)
Clinical Validation Requirements
- Positive blood culture for Group B Streptococcus
- Systemic inflammatory response syndrome (SIRS) criteria
Code-Specific Risks
- Misclassification if not supported by blood culture results.
Coding Notes
- Ensure documentation specifies Group B Streptococcus as the causative agent.
B95.1 - Streptococcus, group B, as the cause of diseases classified elsewhere
Use as a secondary code to specify the organism in infections classified elsewhere.
Applicable To
- Group B Streptococcus as the cause of disease
Clinical Validation Requirements
- Laboratory confirmation of Group B Streptococcus as the causative organism.
Coding Notes
Ensure linkage to the primary infection code.
Z22.330 - Carrier of Group B streptococcus
Use for asymptomatic carriers, especially in pregnancy.
Applicable To
- Asymptomatic carrier of Group B Streptococcus
Excludes
- Active infection due to Group B Streptococcus
Clinical Validation Requirements
- Positive rectovaginal culture for Group B Streptococcus without symptoms.
Coding Notes
Document carrier status clearly to avoid confusion with active infection.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Streptococcus, group B, as the cause of diseases classified elsewhere
B95.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Group B Streptococcus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A40.1.
Impact
Clinical: Misrepresents patient condition., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Verify clinical documentation before coding., Educate staff on differences between colonization and infection.
Impact
Reimbursement: Incorrect coding can lead to inappropriate DRG assignment., Compliance: May trigger audits if coding does not match clinical documentation., Data Quality: Affects accuracy of infection tracking and reporting.
Mitigation Strategy
Use Z22.330 for carriers and A40.1 for active infections.
Impact
Incorrect use of Z22.330 for active infections.
Mitigation Strategy
Regular training on distinguishing colonization from infection.
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 Group B Streptococcus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Group B Streptococcus
Use these documentation templates to ensure complete and accurate documentation for Group B Streptococcus. These templates include all required elements for proper coding and billing.
GBS carrier in pregnancy
Specialty: OB/GYNRequired Elements
- GBS status
- Screening method
- Intrapartum prophylaxis
- Clinical findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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