ICD-10 Coding for History of Clostridium difficile Infection(A04.71, A04.72, Z86.19)
Complete ICD-10-CM coding and documentation guide for History of Clostridium difficile Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Clostridium difficile Infection
Other bacterial intestinal infections
Used for active Clostridium difficile infections, both recurrent and non-recurrent.
Z86.19Primary Range
Personal history of other infectious and parasitic diseases
Used for documenting a resolved history of Clostridium difficile 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 |
|---|---|---|---|
| A04.71 | Enterocolitis due to Clostridium difficile, recurrent | Use when the patient has had two or more episodes of C. difficile infection within six months. |
|
| A04.72 | Enterocolitis due to Clostridium difficile, non-recurrent | Use for a single episode of C. difficile infection or when episodes are more than 8 weeks apart. |
|
| Z86.19 | Personal history of other infectious and parasitic diseases | Use when the C. difficile infection is resolved and no longer being treated. |
|
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: When to use Z86.19 for C. difficile
Essential facts and insights about History of Clostridium difficile Infection
Primary ICD-10-CM Codes for history of clostridium difficile
Decision Criteria
clinical Criteria
- Recurrent episodes documented within 6 months
Applicable To
- Recurrent C. difficile infection
Excludes
- Non-recurrent C. difficile infection (A04.72)
Clinical Validation Requirements
- Documentation of recurrent episodes within 6 months
- Positive stool PCR/toxin test
Code-Specific Risks
- Incorrectly coding resolved infections as recurrent
Coding Notes
- Ensure documentation specifies recurrence and treatment details.
A04.72 - Enterocolitis due to Clostridium difficile, non-recurrent
Use for a single episode of C. difficile infection or when episodes are more than 8 weeks apart.
Applicable To
- Non-recurrent C. difficile infection
Excludes
- Recurrent C. difficile infection (A04.71)
Clinical Validation Requirements
- Single episode or episodes more than 8 weeks apart
- Positive stool PCR/toxin test
Coding Notes
Ensure documentation specifies non-recurrence and treatment details.
Z86.19 - Personal history of other infectious and parasitic diseases
Use when the C. difficile infection is resolved and no longer being treated.
Applicable To
- History of resolved C. difficile infection
Clinical Validation Requirements
- Documentation of resolved infection
- No current symptoms or treatment
Coding Notes
Ensure documentation clearly states the infection is resolved.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other long term (current) drug therapy
Z79.899Differential 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 History of Clostridium difficile Infection 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 documentation standards., Financial: Potential for denied claims or incorrect reimbursement.
Mitigation Strategy
Ensure clear documentation of resolved status, Regular training on documentation standards
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use A04.71 or A04.72 for active infections.
Impact
Using Z86.19 for active infections can lead to audit findings.
Mitigation Strategy
Regular audits and coder education on proper code usage.
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 History of Clostridium difficile Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Clostridium difficile Infection
Use these documentation templates to ensure complete and accurate documentation for History of Clostridium difficile Infection. These templates include all required elements for proper coding and billing.
Resolved C. difficile infection
Specialty: Internal MedicineRequired Elements
- Resolution status
- Last treatment date
- Current symptom status
- Negative lab results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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