Category Archives: Infectious Diseases
December 14, 2011 Necrotising Fasciitis
This is a rapidly advancing infection of the soft tissue usually caused by an infection of two bacterial species and can be fatal if not surgically treated. The correct ICD-10 code for this condition is M72.5 Fasciitis, not elsewhere classified. An additional code should be used to identify the bacteria if known. The index trail is:
Index trail:
Fasciitis
– Specified NEC M72.5
Tabular list:
M72.5 Fasciitis, not elsewhere classified
Date published: 10/1995 (Issue 24)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: fasciitis, soft tissue diseases
December 14, 2011 Group B Streptococcus Bacterial Infections
Group B Streptococcus (GBS) has been recognised as the primary cause of bacterial infection in new-born babies, resulting in disease at birth and up to three months of age. It is the most common cause of meningitis in new-borns.
It also causes illness in pregnant women, the elderly, and in adults with other diseases such as diabetes or liver disease. This bacterium is normally found in the vagina and/or lower intestine of 10-30% of all healthy, adult women. Those patients who test positive for GBS are said to be colonised.
GBS is diagnosed by a laboratory test of blood or spinal fluid, or by swab or urine analysis. GBS should not be confused with Group A Streptococcus, which causes strep throat and severe maternal sepsis after delivery. GBS can be present in a woman’s first pregnancy, or in subsequent pregnancies. It can be a threat during pregnancy, at the time of delivery and afterwards.
The majority of GBS infections are acquired during childbirth when the baby comes into direct contact with the bacteria carried by the mother, either by the bacteria travelling upward from the mother’s vagina into the uterus, or as the infant passes through the birth canal. Illness occurs when the bacterium enters the baby’s bloodstream. Some doctors routinely screen for GBS by taking cultures, during pregnancy, from the lower vagina or rectum, or the cervix. Women who are found to carry the bacteria can then be treated as potential GBS risk patients.
A mother colonised with GBS, would be coded as:
Z22.3 Carrier of other specified bacterial diseases
A newborn baby diagnosed with GBS by blood test or spinal fluid, would be coded as:
P36.0 Sepsis of newborn due to streptococcus, group B
Z38.0 Singleton, born in hospital
A newborn baby receiving prophylactic antibiotics whose mother has previously had a streptococcus infection, would be coded as:
Z38.0 Singleton, born in hospital
Z29.2 Other prophylactic chemotherapy
Z83.1 Family history of other infectious and parasitic diseases
A newborn baby whose umbilical swab, or other surface swabs, for example: ear, skin eye etc, is found to be positive for streptococcus Group B with no signs of infection, would be coded as:
Z38.0 Singleton, born in hospital
Z22.3 Carrier of other specified bacterial diseases
Date published: 11/2004 (Volume 1 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: GBS, neonatology, obs, obstetrics, streptococcus, z codes
December 14, 2011 Tonsillitis
Acute tonsillitis is inflammation of the tonsillar tissue, which may be viral or bacterial in origin.
Recurrent tonsillitis refers to multiple distinct episodes of acute tonsillitis. Each presentation should be diagnosed and documented using the same criteria as for acute tonsillitis. Specific management of each episode will be determined by the suspected aetiology (viral or bacterial).
Chronic tonsillitis is an ill-defined entity, which may be associated with foci of bacteria deep in tonsillar tissue. It is characterized by persistent signs and symptoms of low-grade infection, including sore throat, malaise and abnormal tonsillar appearance. Consideration should be given to aggressive oral antibiotic therapy, but each individual case will merit specific management strategies.
The UK Coding Review Panel has sought clinical input regarding the coding of tonsillitis. The advice given was that acute tonsillitis is sometimes a reason for emergency admission to hospital, chronic tonsillitis almost never is.
Admissions to hospital for elective tonsillectomy are most commonly for recurrent acute tonsillitis.
Example 1:
Diagnosis: Tonsillitis
Index Trail:
Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9
Tabular:
J03.9 Acute tonsillitis, unspecified
When a diagnostic statement is described as a single term which has no modifiers, it is said to be unspecified or NOS (not otherwise specified). The code assignment is that which follows the lead term.
Example 2:
Diagnosis: Tonsillitis (acute)
Index Trail:
Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9
Tabular List:
J03.9 Acute tonsillitis, unspecified
Example 3:
Diagnosis: Chronic tonsillitis
Index Trail:
Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9
– chronic J35.0
Tabular:
J35.0 Chronic tonsillitis
In this scenario chronic is an essential modifier and therefore must be present in the diagnostic statement to be able to assign J35.0 Chronic tonsillitis. When following the four step coding process it is important to note the excludes note at J35.0, which excludes tonsillitis NOS and directs the coder to assign a code of J03.9.
Example 4:
Diagnosis: Recurrent tonsillitis
Index Trail:
Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9
Tabular List:
J03.9 Acute tonsillitis, unspecified
There is no essential modifier for ‘recurrent’ therefore the index trail for tonsillitis leads to J03.9 Acute tonsillitis, unspecified which includes Tonsillitis (acute).
Update history
12/2011: Unnecessary ICD-10 index trails and OPCS-4 codes have been removed to make the guidance more concise.
Date first published: 10/2005 (Volume 2 Issue 2)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Related articles
- Too few tonsillectomies ‘risks health’ (bbc.co.uk)
Tags: respiratory system, tonsillitis
December 14, 2011 Vaginal Thrush in Pregnancy
Q. What are the correct ICD-10 codes to record vaginal thrush in pregnancy?
A. The correct ICD-10 codes for vaginal thrush in pregnancy are:
O23.5 Infections of the genital tract in pregnancy
B37.3† Candidiasis of vulva and vagina (N77.1*)
N77.1* Vaginitis, vulvitis and vulvovaginitis in infectious and parasitic diseases classified elsewhere
Date published: 06/2008 (Volume 5 Issue 1)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: candidiasis, infectious diseases, obs, obstetrics, vaginal thrush
December 14, 2011 Elective Caesarean for HIV
Q. Can you please advise which ICD-10 codes should be assigned to the mother’s episode of care when a baby is delivered by elective caesarean, because the mother has been diagnosed with HIV?
A. If the patient is asymptomatic HIV positive, and the HIV is not causing any current medical problems, then the appropriate ICD-10 codes are:
O82.0 Delivery by elective caesarean section
Z37.0 Single live birth
Z21.X Asymptomatic human immunodeficiency virus [HIV] infection status
However if, the patient is suffering from active HIV and this is causing associated medical problems, then the appropriate ICD-10 codes are:
O82.0 Delivery by elective caesarean section
Z37.0 Single live birth
B20-B24 Human immunodeficiency virus [HIV] disease (plus any associated problems, including asterisk codes where necessary).
Note: Human immunodeficiency virus [HIV] disease (B20-B24) is referred to at the Exclusion Note at ICD-10 category O98.- Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium.
Date published: 02/2009 (Volume 5 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: caesarean, HIV, obs, obstetrics
December 14, 2011 Influenza A (H1N1) [swine flu]
The NHS Classifications Service has been closely following the deliberations of the World Health Organisation regarding the classification of Swine Flu in ICD-10.
For consistency within the UK NHS, we are providing clarification on how to classify this disease within the current NHS Information Standard ICD-10 (2000 reprint version).
The appropriate ICD-10 code assignment for this disease, where no manifestations have been identified, is J10.1 Influenza with other respiratory manifestations, influenza virus identified. This code is arrived at by use of the ICD-10 alphabetical index and the full four step coding process:
Swine flu
Index trail for Influenza:
Influenza (specific virus not identified) J11.1
– virus identified J10.1
Tabular List entry:
J10.1 Influenza with other respiratory manifestations, Influenza virus identified
The correct ICD-10 code to assign is J10.1 Influenza with other respiratory manifestations, Influenza virus identified.
If other specific manifestations of the influenza are identified, the whole of ICD-10 category J10.- Influenza due to identified influenza virus, should be considered where appropriate.
Date published: 06/2009 (Volume 6 Issue 1)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Related articles
- NHS orders 2m extra flu vaccines (bbc.co.uk)
Tags: infectious diseases, influenza, swine flu
December 13, 2011 Leg Ulcers with Gangrene, Infection and Cellulitis
When coding leg ulcers using ICD-10 codes it is important that associated gangrene and/or infection of the affected leg are coded in addition to the leg ulcer:
If the infective agent has been identified, then an additional code from ICD-10 categories B95-B97 Bacterial, viral and other infectious agents, must be assigned as a supplementary code.
Leg ulcer with gangrene
Example 1:
Patient diagnosed with a leg ulcer and gangrene of the leg. The correct ICD-10 codes and sequence are:
L97.X Ulcer of lower limb, not elsewhere classified
R02.X Gangrene, not elsewhere classified
Example 2:
Patient diagnosed with a leg ulcer and gangrene of the leg due to type 2 diabetes mellitus. The correct ICD-10 codes and sequence are:
E11.5 Non-insulin-dependent diabetes mellitus, with peripheral circulatory complications
L97.X Ulcer of lower limb, not elsewhere classified
R02.X Gangrene, not elsewhere classified
Infected leg ulcer
Example 3:
Patient diagnosed with an infected/infectious leg ulcer. Streptococcus group A is identified as the infectious agent. The correct ICD-10 codes and sequence are:
L97.X Ulcer of lower limb, not elsewhere classified
L08.9 Local infection of skin and subcutaneous tissue, unspecified
B95.0 Streptococcus, group A, as the cause of disease classified to other
chapters
Leg ulcer with cellulitis of the leg
Cellulitis is the spreading of inflammation. It is a bacterial infection which usually enters the skin via a wound or another break in the skin. The affected area is hot, tender and red. The patient may also be feverish and have chills. Treatment usually consists of elevation, rest and administration of pathogen-specific antibiotics. If cellulitis of the leg is mentioned with a leg ulcer, then both conditions must be coded. Clinical advice must be sought if it is not clear whether the cellulitis or the leg ulcer is the main condition being treated during the relevant episode of care.
Example 4:
Patient is admitted with cellulitis of the leg and a superficial leg ulcer. The cellulitis is responding poorly to oral antibiotics. A decision is made to treat the cellulitis with intravenous antibiotics. The correct ICD-10 codes and sequence are:
L03.1 Cellulitis of other parts of limb
L97.X Ulcer of lower limb, not elsewhere classified
Example 5:
A patient is admitted with cellulitis of the leg and a severe leg ulcer. The cellulitis is responding well to treatment with oral antibiotics, but the leg ulcer is showing no signs of healing. The patient is sent to theatre for debridement of the leg ulcer under general anaesthetic.
The correct ICD-10 codes and sequence are:
L97.X Ulcer of lower limb, not elsewhere classified
L03.1 Cellulitis of other parts of limb
Date published: 05/2010 (Volume 7 Issue 2)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: cellulitis, diabetes, gangrene, leg ulcers, skin
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- Posted under A00–B99 Certain infectious and parasitic diseases, E00–E90 Endocrine, nutritional and metabolic diseases, General Medicine, Infectious Diseases, L00–L99 Diseases of the skin and subcutaneous tissue, R00–R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
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