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A04.72
ICD-10-CM
C. diff Infection

Learn about C. diff infection (Clostridioides difficile infection) diagnosis, including clinical documentation requirements and medical coding for C. difficile colitis and pseudomembranous colitis. Find information on healthcare best practices for diagnosing C. diff, along with relevant ICD-10 and SNOMED CT codes for accurate medical records. This resource helps healthcare professionals ensure proper coding and documentation for C. diff infections.

Also known as

Clostridioides difficile Infection
C. difficile Colitis
Pseudomembranous Colitis

Diagnosis Snapshot

Key Facts
  • Definition : Bacterial infection causing inflammation of the colon, often after antibiotic use.
  • Clinical Signs : Watery diarrhea, abdominal pain, fever, nausea, and dehydration.
  • Common Settings : Hospitals, nursing homes, and healthcare facilities where antibiotic use is prevalent.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC A04.72 Coding
A04.7

Enterocolitis due to Clostridium difficile

Infection of the large intestine caused by C. diff bacteria.

A04

Other bacterial intestinal infections

Bacterial infections of the intestines not otherwise specified.

K52

Noninfective gastroenteritis and colitis

Inflammation of the stomach and intestines not due to infection.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the C. diff infection confirmed?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Bacterial infection causing colon inflammation.
Inflammation of the colon from various causes.
Inflammation of the colon lining with pseudomembranes.

Documentation Best Practices

Documentation Checklist
  • Document onset date of C. diff diarrhea.
  • Describe diarrhea frequency and characteristics.
  • Record positive C. diff lab test result (e.g., PCR, EIA).
  • Document related antibiotic use, if applicable.
  • Note any complications like dehydration or toxic megacolon.

Coding and Audit Risks

Common Risks
  • Unspecified C. diff

    Coding C. diff without specifying infection type (e.g., primary, recurrent) can lead to inaccurate severity and reimbursement.

  • PMC vs. C. diff

    Miscoding pseudomembranous colitis as C. diff without confirming etiology may cause claims denials and quality issues.

  • C. diff CDI Query

    Insufficient clinical documentation for C. diff can lead to coding queries, impacting CDI efficiency and reimbursement.

Mitigation Tips

Best Practices
  • Isolate C. diff patients. Use contact precautions.
  • Proper hand hygiene. Soap and water preferred over alcohol.
  • Disinfect with sporicidal agents. EPA-approved list.
  • Antibiotic stewardship. Limit use to treat only indicated infections.
  • Prompt testing and diagnosis. ICD-10 A04.7, CDI documentation.

Clinical Decision Support

Checklist
  • Recent antibiotic use? Document type and duration.
  • ≥3 loose stools in 24 hours? Document stool characteristics.
  • Consider C. diff testing: PCR or GDH+toxin EIA. Document indication.
  • Positive test? Isolate patient. Document precautions.
  • Start appropriate C. diff treatment. Document regimen.

Reimbursement and Quality Metrics

Impact Summary
  • C diff Infection reimbursement impacts DRG assignment, potentially affecting hospital payments.
  • Coding accuracy for C diff, including CDI type and severity, is crucial for appropriate reimbursement.
  • Accurate C diff diagnosis reporting impacts hospital quality metrics like infection rates and readmissions.
  • Proper CDI documentation and coding affect value-based purchasing programs and pay-for-performance incentives.

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Frequently Asked Questions

Common Questions and Answers

Q: What are the most effective C. diff treatment strategies for recurrent Clostridioides difficile infection in older adults considering antibiotic stewardship principles?

A: Recurrent Clostridioides difficile infection (CDI) in older adults presents a significant clinical challenge, often complicated by comorbidities and polypharmacy. Effective treatment strategies necessitate a balance between resolving the immediate infection and minimizing the risk of further recurrence while adhering to antibiotic stewardship principles. First-line treatment for an initial recurrence is typically a pulsed-tapered course of vancomycin or fidaxomicin. For subsequent recurrences, fidaxomicin is generally preferred due to its lower recurrence rates. Bezlotoxumab, a monoclonal antibody targeting C. difficile toxin B, can be considered as adjunctive therapy for patients at high risk of recurrence. Fecal microbiota transplantation (FMT) has emerged as a highly effective treatment for multiple recurrent CDI, offering sustained remission in a significant proportion of patients. Careful consideration of patient-specific factors, including age, comorbidities, and prior antibiotic exposure, is crucial when tailoring treatment. Explore how implementing a multidisciplinary approach involving infectious disease specialists, gastroenterologists, and geriatricians can optimize outcomes in this complex patient population. Consider implementing institutional guidelines that align with current IDSA/SHEA guidelines for C. diff management.

Q: How can I differentiate between C. diff colitis and other causes of infectious diarrhea in a hospitalized patient with recent antibiotic exposure?

A: Differentiating Clostridioides difficile colitis (C. diff) from other causes of infectious diarrhea in hospitalized patients with recent antibiotic exposure requires a comprehensive approach. While the presence of diarrhea following antibiotic use is suggestive, it's not specific to C. diff. Key clinical features to consider include the presence of watery or semi-formed stools, abdominal pain or cramping, fever, and a characteristic foul odor. Laboratory testing is essential for confirmation, with nucleic acid amplification tests (NAATs) being the preferred diagnostic method due to their high sensitivity and specificity. Consider evaluating for other infectious etiologies, such as viral gastroenteritis or bacterial infections like Salmonella or Campylobacter, especially if NAATs for C. diff are negative. A thorough patient history, including details about antibiotic use, recent hospitalization, and potential exposure to contaminated environments, is critical. Learn more about the clinical presentation and diagnostic workup of C. diff infection to enhance your diagnostic accuracy and ensure appropriate patient management.

Quick Tips

Practical Coding Tips
  • Code C. diff first, other diagnoses secondary
  • Document antibiotic use and duration
  • Query physician for colitis specifics if unclear
  • Check for CDI lab test confirmation
  • Rule out other colitis causes if applicable

Documentation Templates

Patient presents with complaints consistent with Clostridioides difficile infection (CDI), also known as C. diff colitis or pseudomembranous colitis.  Onset of symptoms, including diarrhea described as watery or loose stools, abdominal pain, and cramping, began [Number] days ago.  The patient reports [Number] bowel movements per day.  Associated symptoms may include nausea, fever, dehydration, and loss of appetite.  Recent antibiotic use within the past [Number] weeks is documented as [Antibiotic Name and Dosage].  The patient denies recent hospitalization or healthcare facility exposure.  Physical examination reveals [Findings, e.g., mild tenderness to palpation in the lower abdomen, hyperactive bowel sounds].  Stool studies for Clostridium difficile toxins are ordered.  Based on the clinical presentation and risk factors, a presumptive diagnosis of C. diff infection is made.  Treatment is initiated with [Medication Name and Dosage].  Patient education provided on infection control measures, including hand hygiene and contact precautions.  Follow-up scheduled to monitor treatment response and assess for resolution of symptoms.  Differential diagnosis includes other causes of infectious diarrhea and inflammatory bowel disease.  ICD-10 code A04.7 will be used for Clostridium difficile colitis.  This documentation supports medical necessity for C. diff testing and treatment.