Health Information Management

Battling bad bacteria

HIM-HIPAA Insider, August 10, 2015

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Bacteria are everywhere. Literally. And you can’t see them or feel them. In fact, trillions of them are living on your skin right now. So not all bacteria are bad.
 
Some, though, can do nasty things.
 
Consider Legionella pneumophila bacteria. These nasty guys are responsible for at least seven deaths in New York City Legionnaires’ disease outbreak. At least 64 people have been hospitalized.
 
Legionnaires’ disease falls under category A48 (other bacterial diseases, not elsewhere classified) in ICD-10-CM. That’s a new home for the disease. In ICD-9-CM, the code for Legionnaires’ disease falls under diseases of the respiratory system (482.84, in case you’re interested).
 
The disease itself hasn’t changed. It’s just been moved from respiratory to infectious diseases.
 
We also get a second code for Legionnaires’ disease in ICD-10-CM: A48.2 (nonpneumonic Legionnaires’ disease [Pontiac fever]). We don’t have a code for Pontiac fever in ICD-9-CM.
 
Legionnaires’ disease is a type of pneumonia. Pontiac fever is a less severe, flu-like condition caused by the same bacteria.
 
Bacteria are also responsible for a host of other conditions, including necrotizing fasciitis. In ICD-10-CM, we only have one code: M72.6. However, we also have a note instructing us to use an additional code (B95.-, B96.-) to identify causative organism.
 
Our choices are: 
  • Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere (category B95.-)
  • Other bacterial agents as the cause of diseases classified elsewhere (B96.-)

Bacteria, specifically Brucella, are also a really good reason to make sure your food is cooked. Brucella bacteria can cause brucellosis, which manifests with fever, back pain, night sweats, poor appetite, and headaches.

Brucellosis comes in four different strains and your symptoms depend on which one you have. So will code selection. ICD-10-CM includes:

  • 0, brucellosis due to Brucella melitensis
  • 1, brucellosis due to Brucella abortus
  • 2, brucellosis due to Brucella suis
  • 3, brucellosis due to Brucella canis
  • 8, other brucellosis
  • 9, brucellosis, unspecified
What if you don’t know the causative organism? Do you need to query the physician and ask him or her to test for it? No. In fact, the physician shouldn’t do a test just so we can report a more specific code. The ICD-10-CM Official Guidelines for Coding and Reporting tell us so:
 
When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). Unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.
 
I think I’ll skip the steak tartare.

This article originally appeared on
HCPro’s ICD-10 Trainer blog.



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