ICD-10 Coding for History of H. pylori(Z87.11, B96.81)
Complete ICD-10-CM coding and documentation guide for History of H. pylori. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of H. pylori
Z87.11Primary Range
Personal history of peptic ulcer disease
Used for documenting a resolved H. pylori infection that previously caused peptic ulcer disease.
Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
Used as an additional code when H. pylori is the cause of a current disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z87.11 | Personal history of peptic ulcer disease | Use when the patient has a history of H. pylori infection that caused peptic ulcer disease, now resolved. |
|
| B96.81 | Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere | Use as an additional code when H. pylori is causing a current condition. |
|
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 history of H. pylori
Essential facts and insights about History of H. pylori
Primary ICD-10-CM Codes for history of hours pylori
Decision Criteria
clinical Criteria
- Patient has a documented history of H. pylori infection with resolved peptic ulcer.
coding Criteria
- Do not use as a primary diagnosis code.
Applicable To
- History of peptic ulcer due to H. pylori
Excludes
- Current peptic ulcer disease
Clinical Validation Requirements
- Documentation of resolved H. pylori infection
- History of peptic ulcer disease
Code-Specific Risks
- Incorrectly using for active H. pylori infection
Coding Notes
- Z87.11 should not be used as a principal diagnosis.
B96.81 - Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
Use as an additional code when H. pylori is causing a current condition.
Applicable To
- H. pylori as a cause of active disease
Excludes
- History of H. pylori infection
Clinical Validation Requirements
- Active disease caused by H. pylori
- Confirmatory testing for H. pylori
Coding Notes
B96.81 should always be used as a secondary code.
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 History of H. pylori to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z87.11.
Impact
Clinical: Misrepresents patient's current condition., Regulatory: Non-compliance with ICD-10 coding rules., Financial: Potential claim denials due to incorrect coding.
Mitigation Strategy
Verify current vs. historical status of H. pylori infection, Use B96.81 for active conditions
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient's condition.
Mitigation Strategy
Always use B96.81 as a secondary code with the primary condition it causes.
Impact
Reimbursement: May affect DRG assignment and reimbursement., Compliance: Fails to meet documentation standards., Data Quality: Leads to incomplete patient records.
Mitigation Strategy
Specify the history of peptic ulcer disease due to H. pylori and treatment status.
Impact
Using history codes for active conditions can trigger audits.
Mitigation Strategy
Regular training on distinguishing between active and historical conditions.
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 H. pylori, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of H. pylori
Use these documentation templates to ensure complete and accurate documentation for History of H. pylori. These templates include all required elements for proper coding and billing.
Follow-up for GERD with history of H. pylori
Specialty: GastroenterologyRequired Elements
- Patient history of H. pylori infection
- Treatment details and resolution confirmation
- Current symptoms and management plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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