ICD-10 Coding for Staph Infection(A41.02, J15.212)
Complete ICD-10-CM coding and documentation guide for Staph Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Staph Infection
A41.0-A41.9Primary Range
Sepsis due to various organisms
Includes codes for sepsis due to Staphylococcus aureus, including MRSA.
Pneumonia due to Staphylococcus
Covers pneumonia caused by Staphylococcus aureus, including MRSA.
Cutaneous abscess, furuncle, and carbuncle
Includes skin infections caused by Staphylococcus aureus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| A41.02 | Sepsis due to Methicillin-resistant Staphylococcus aureus | Use when sepsis is confirmed to be due to MRSA. |
|
| J15.212 | Pneumonia due to Methicillin-resistant Staphylococcus aureus | Use when pneumonia is confirmed to be due to MRSA. |
|
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 MRSA pneumonia
Essential facts and insights about Staph Infection
Primary ICD-10-CM Codes for staph infection
Decision Criteria
clinical Criteria
- Positive MRSA culture and clinical signs of sepsis.
Applicable To
- MRSA sepsis
Excludes
- Sepsis due to other organisms
Clinical Validation Requirements
- Positive blood culture for MRSA
- Clinical signs of sepsis (e.g., fever, tachycardia)
Code-Specific Risks
- Incorrect use if MRSA is not confirmed by culture.
Coding Notes
- Ensure MRSA is documented as the causative organism.
J15.212 - Pneumonia due to Methicillin-resistant Staphylococcus aureus
Use when pneumonia is confirmed to be due to MRSA.
Applicable To
- MRSA pneumonia
Excludes
- Pneumonia due to other organisms
Clinical Validation Requirements
- Chest X-ray showing pneumonia
- Sputum culture positive for MRSA
Coding Notes
Ensure MRSA is documented as the causative organism.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Severe sepsis without septic shock
R65.20Differential 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 Staph Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code A41.02.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Educate providers on the importance of specifying the organism., Implement documentation templates.
Impact
Reimbursement: May lead to incorrect billing and potential denial of claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Do not use B95.62 when a combination code is available.
Impact
Using B95.62 with codes like J15.212.
Mitigation Strategy
Educate coders on proper use of combination codes.
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 Staph Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Staph Infection
Use these documentation templates to ensure complete and accurate documentation for Staph Infection. These templates include all required elements for proper coding and billing.
MRSA pneumonia with sepsis
Specialty: PulmonologyRequired Elements
- Patient history
- Physical examination findings
- Laboratory results
- Radiological findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Staph Infection? Ask your questions below.