ICD-10 Coding for Streptococcal Infections(J02.0, A38.9, A40.0)
Complete ICD-10-CM coding and documentation guide for Streptococcal Infections. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Streptococcal Infections
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J02.0 | Streptococcal pharyngitis | Use when pharyngitis is confirmed to be caused by Group A Streptococcus. |
|
| A38.9 | Scarlet fever | Use when scarlet fever is diagnosed with characteristic rash and pharyngitis. |
|
| A40.0 | Sepsis due to Streptococcus, group A | Use when sepsis is confirmed to be caused by Group A Streptococcus. |
|
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 streptococcal pharyngitis
Essential facts and insights about Streptococcal Infections
Primary ICD-10-CM Codes for streptococcus
Decision Criteria
clinical Criteria
- Positive RADT or culture for Group A Streptococcus
Applicable To
- Strep throat
Excludes
- Acute tonsillitis (J03.-)
Clinical Validation Requirements
- RADT or culture positive for Group A Streptococcus
Code-Specific Risks
- Incorrectly coding as J02.9 without confirmation.
Coding Notes
- Ensure RADT or culture results are documented.
A38.9 - Scarlet fever
Use when scarlet fever is diagnosed with characteristic rash and pharyngitis.
Applicable To
- Scarlatina
Excludes
- Streptococcal sore throat (J02.0)
Clinical Validation Requirements
- Presence of scarlatiniform rash and pharyngitis
Coding Notes
Document rash and pharyngitis clearly.
A40.0 - Sepsis due to Streptococcus, group A
Use when sepsis is confirmed to be caused by Group A Streptococcus.
Applicable To
- Streptococcal sepsis
Excludes
- Sepsis due to other organisms (A41.-)
Clinical Validation Requirements
- Blood culture positive for Streptococcus
Coding Notes
Sequence sepsis codes correctly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Streptococcal Infections to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J02.0.
Impact
Clinical: Inaccurate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document blood culture results, Specify organism in clinical notes
Impact
Reimbursement: Potential denial of claims due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure RADT or culture confirms Group A Streptococcus.
Impact
Reimbursement: Claims may be rejected for incomplete coding., Compliance: Failure to adhere to ICD-10 coding structure., Data Quality: Incomplete data affecting clinical decision-making.
Mitigation Strategy
Include the appropriate 7th character for encounter type.
Impact
Incorrect sequencing of sepsis and organism codes.
Mitigation Strategy
Regular training on coding guidelines and audits.
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 Streptococcal Infections, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Streptococcal Infections
Use these documentation templates to ensure complete and accurate documentation for Streptococcal Infections. These templates include all required elements for proper coding and billing.
Acute streptococcal pharyngitis
Specialty: Primary CareRequired Elements
- Patient history
- RADT results
- Physical exam findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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