ICD-10 Coding for Proteus Infections and Syndrome(B96.4, Q87.3)
Complete ICD-10-CM coding and documentation guide for Proteus Infections and Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Proteus Infections and Syndrome
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B96.4 | Proteus (mirabilis) as the cause of diseases classified elsewhere | Use when Proteus is identified as the causative organism in an infection. |
|
| Q87.3 | Other congenital malformation syndromes, not elsewhere classified | Use for confirmed cases of Proteus syndrome. |
|
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 Proteus infection
Essential facts and insights about Proteus Infections and Syndrome
Primary ICD-10-CM Codes for proteus
Decision Criteria
clinical Criteria
- Proteus species identified in culture
coding Criteria
- Site of infection must be coded first
Applicable To
- Proteus mirabilis infection
Excludes
- Proteus syndrome (Q87.3)
Clinical Validation Requirements
- Culture and sensitivity report confirming Proteus species
- Documentation of the site of infection
Code-Specific Risks
- Incorrectly using as a principal diagnosis
Coding Notes
- B96.4 should not be used as a primary diagnosis code.
Q87.3 - Other congenital malformation syndromes, not elsewhere classified
Use for confirmed cases of Proteus syndrome.
Applicable To
- Proteus syndrome
Excludes
- Other specific congenital syndromes
Clinical Validation Requirements
- Clinical diagnosis based on established criteria
- Genetic testing confirming AKT1 mutation
Coding Notes
Ensure documentation of clinical criteria and genetic confirmation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Multidrug-resistant Proteus mirabilis
U81.27Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Escherichia coli as the cause of diseases classified elsewhere
B96.5Congenital malformation syndromes predominantly affecting facial appearance
Q87.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Proteus Infections and Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B96.4.
Impact
Clinical: May lead to inappropriate antibiotic use., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always document resistance patterns when present.
Impact
Reimbursement: May lead to claim denial or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient data.
Mitigation Strategy
Always pair with a primary code for the site of infection.
Impact
Failure to document organism and resistance leads to audit flags.
Mitigation Strategy
Ensure all relevant clinical findings are documented.
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 Proteus Infections and Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Proteus Infections and Syndrome
Use these documentation templates to ensure complete and accurate documentation for Proteus Infections and Syndrome. These templates include all required elements for proper coding and billing.
Proteus mirabilis infection with resistance
Specialty: Infectious DiseaseRequired Elements
- Site of infection
- Organism identified
- Resistance pattern
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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