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A31.0
ICD-10-CM
Mycobacterium avium complex

Find comprehensive information on Mycobacterium avium complex MAC diagnosis including clinical documentation requirements ICD 10 codes and SNOMED CT terminology. Learn about MAC infection symptoms treatment and diagnostic testing for accurate medical coding and improved healthcare outcomes. This resource offers guidance for clinicians on documenting MAC disease including pulmonary and disseminated infections for proper billing and reimbursement. Explore resources related to MAC prophylaxis and management strategies.

Also known as

MAC
M. avium-intracellulare
M. avium
+1 more

Diagnosis Snapshot

Key Facts
  • Definition : Bacterial infection caused by Mycobacterium avium complex, often affecting lungs.
  • Clinical Signs : Cough, fatigue, weight loss, fever, night sweats, shortness of breath.
  • Common Settings : Immunocompromised individuals, especially those with HIV or lung disease.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC A31.0 Coding
A31

Pulmonary mycobacterial diseases

Covers lung infections caused by Mycobacterium avium complex (MAC).

R79.89

Other specified abnormal findings of blood chemistry

May be used for disseminated MAC infection affecting multiple organ systems.

B90.8

Other specified bacterial agents as the cause of diseases classified elsewhere

Can capture MAC infections impacting locations beyond the lungs.

Code-Specific Guidance

Decision Tree for

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

Is the MAC infection pulmonary?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Mycobacterium avium complex lung disease
Lady Windermere syndrome
Nontuberculous mycobacterial lung disease

Documentation Best Practices

Documentation Checklist
  • MAC diagnosis: Symptoms (cough, fever, weight loss)
  • MAC diagnosis: Imaging (chest x-ray, CT scan) findings
  • MAC diagnosis: Culture confirmation (specify specimen)
  • MAC diagnosis: Species identification (if available)
  • MAC diagnosis: Drug susceptibility testing results

Coding and Audit Risks

Common Risks
  • MAC Diagnosis Coding

    Inaccurate coding of MAC (Mycobacterium avium complex) infections, differentiating between pulmonary and disseminated disease (A31.0 vs. A31.8).

  • MAC Clinical Documentation

    Insufficient documentation to support MAC diagnosis specificity for coding and reimbursement, impacting CDI efforts.

  • MAC Compliance Auditing

    Risk of audits focusing on MAC cases due to coding complexity and potential overpayments for lacking documentation.

Mitigation Tips

Best Practices
  • Document symptoms, acid-fast bacilli (AFB) smears/cultures, imaging. ICD-10: A31.0, MAC lung disease
  • Specify disease site (pulmonary, disseminated) for accurate MAC coding, CDI, compliance.
  • For disseminated MAC, document HIV status, CD4 count. ICD-10: B20.0, HIV; A31.8, other MAC
  • Distinguish MAC from TB. Order specific tests (e.g., PCR). Improves CDI, healthcare compliance.
  • Record treatment details (e.g., macrolide, ethambutol). Ensures proper MAC coding, billing.

Clinical Decision Support

Checklist
  • 1. Symptoms: Fever, cough, weight loss documented? ICD-10: A15-A16
  • 2. AFB smear and culture ordered and reviewed? CPT: 87116
  • 3. Imaging (CXR) findings consistent with MAC? Document nodules/infiltrates.
  • 4. Consider HIV status. ICD-10: B20, Z21
  • 5. Exclude other diagnoses. Differential documented?

Reimbursement and Quality Metrics

Impact Summary
  • Mycobacterium avium complex reimbursement hinges on accurate ICD-10-CM coding (A31.0) and appropriate DRG assignment for optimal hospital payment.
  • MAC diagnosis coding quality impacts Case Mix Index (CMI), affecting hospital reimbursement and public quality reporting.
  • Accurate MAC diagnosis coding is crucial for appropriate antibiotic stewardship program reporting and resource allocation.
  • Timely MAC identification and coding influence hospital length of stay, impacting resource utilization and cost metrics.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code MAC, not MAI
  • Document site, drug resistance
  • Confirm with culture, PCR
  • ICD-10 M. avium codes
  • Check guidelines for combination Rx

Documentation Templates

Patient presents with signs and symptoms suggestive of Mycobacterium avium complex (MAC) infection.  Clinical presentation includes chronic cough, fatigue, weight loss, night sweats, and low-grade fever.  Pulmonary MAC disease is suspected, given the patient's respiratory symptoms and history of  underlying lung diseasebronchiectasis.  Sputum samples have been collected for acid-fast bacilli (AFB) smear and culture, and further diagnostic testing, including chest X-ray and high-resolution computed tomography (HRCT) of the chest, is ordered to evaluate for pulmonary infiltrates, nodules, or cavitary lesions consistent with MAC lung disease.  Differential diagnosis includes other nontuberculous mycobacterial (NTM) infections, tuberculosis, and fungal infections.  Patient's medical history includes COPD, increasing the risk for NTM pulmonary infections.  Treatment for disseminated MAC infection or pulmonary MAC disease, if confirmed, will be considered based on culture results, disease severity, and symptom burden, and may include a macrolide antibiotic such as azithromycin or clarithromycin, ethambutol, and rifampin, in accordance with current ATSID guidelines.  Patient education regarding medication adherence, potential side effects, and the importance of follow-up care will be provided.  ICD-10 code A31.0 for pulmonary MAC and appropriate SNOMED CT codes will be used for documentation and billing purposes. The patient will be monitored for treatment response and potential adverse drug reactions.