Antibiotic Resistant Infections and Related ICD-10 Codes

Hello everyone and welcome to our podcast series!

My name is Natalie Tornese and I’m a Senior Solutions Manager at Outsource Strategies International (OSI). I wanted to take this opportunity to talk about antibiotic resistant infections.

Antibiotic resistance is one of the biggest public health challenges of our time, according to the CDC. It is critical for infectious disease physicians to ensure the correct diagnosis, treatment, and coding of antibiotic resistance. However, with all the changing guidelines, coding medication resistance to super bug infections can be a challenging task.

So, what is antibiotic resistance?

The Association of Clinical Documentation Integrity Specialists (ACDIS) defines antibiotic resistance as “the ability of bacteria and other microorganisms to resist the effects of an antibiotic to which they were once sensitive”.

Antibiotic resistance occurs when microorganisms such as bacteria, fungi, viruses, and parasites become resistant to the antibiotics designed to kill them and they continue to grow.

Contagion reported the most serious super bugs facing the US in 2019 are:

• Clostridium difficile
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Drug-resistant Neisseria gonorrhoeae
• Methicillin-resistant Staphylococcus aureus, known as MRSA
• Extended-spectrum beta-lactamase producing Enterobacteriaceae
• Candida auris

Others are enter ococcus, klebsiella, acinetobacter, and pseudomonas. They are other multi-drug resistant infections that pose a threat to human health. On its website, the CDC states that it is working towards releasing an AR Threats Report.

Antibiotics are powerful medicines used to treat diseases caused by bacteria. They prevent the reproduction of bacteria or they kill the bacteria. Antibiotics have saved lives, and proved successful in treating chronic diseases and infections that occur in patients, especially patients receiving chemotherapy treatments or in people who have complex surgeries. However, the overuse of antibiotics has dissipated the benefits.

The root causes of antibiotic resistance are:

• Inappropriate use – like when you are prescribing antimicrobials for a viral infection
• Prescriptions based on inappropriate diagnostics or over-prescription – when you are prescribed an antibiotic “just-in-case” or prescribing a broad-spectrum antibiotic when a specific antibiotic may be more suitable or
• For patients not completing the entire antibiotic course
• Overuse of antibiotics in agricultural feed and fish farming
• Poor infection control in health care settings
• Poor hygiene and sanitation and
• Insufficient new antibiotics under development

Absence of effective antibiotics for the prevention and treatment of infection leads to prolonged illness, disability, and even death. New resistance mechanisms pose high risks for medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery. The cost of treating antibiotic resistance (AR) is much higher than for treating non-resistant infections, resulting in lengthier stays in hospitals, extensive testing, and more costly drugs.

Treating medication resistance is a formidable challenge for hospitals and practitioners. In addition to costly patient isolation methods, coding antibiotic-resistant infections can significantly impact revenue, especially if patients get these infections during a hospital stay. Healthcare providers need to correctly diagnose the infection and report it using the correct codes.

I will include a transcript along with this podcast, outlining the specific ICD-10 codes relating to antibiotic drug resistance.

So, there are some guidelines that I would like to talk about for utilizing the ICD-10 code Z16.

It is necessary to identify all infections documented as antibiotic resistant. You would assign a code from category Z16, which is resistance to antimicrobial drugs, following the infection code only if the infection code does not identify drug resistance. The codes in the Z16 category are to be used as additional codes to identify the resistance and non-responsiveness of a condition to antimicrobial drugs.

Type 1 Excludes

• Methicillin resistant Staphylococcus aureus infection (A49.02)
• Methicillin resistant Staphylococcus aureus pneumonia (J15.212) and
• Sepsis due to Methicillin resistant Staphylococcus aureus (A41.02)

The steps to code antibiotic resistance are as follows:

• Identify the infection/type of bacteria by reviewing the supporting documentation. This includes the culture reports, the physician progress notes, the medication administration records, and any other ancillary testing used to identify the resistance
• You would assign a Z code to describe the resistance (e.g., resistance to antimicrobial drugs – those codes were Z16.10 to Z16.39)
• If the patient has been on antibiotics for a long time, that would also be coded.

According to a recent news report from the Center for Infectious Disease Research and Policy (CIDRAP), Medicare is making changes in the way hospitals are paid for the use of new antibiotics and for treating patients with antibiotic-resistant infections.

Under bundled payments, hospitals get a fixed fee for each Medicare patient they treat, but those payments presume the use of older antibiotics. The hospital is not reimbursed appropriately if the physician treats the patient using a newer, more effective, expensive antibiotic. This payment structure undervalues antibiotics and discourages antibiotic innovation.

CMS is changing the severity level designation for 18 ICD-10 codes that specify a drug-resistant infection to “CC,” which indicates the presence of a complication or comorbidity in an inpatient that requires the allocation of more resources to provide care.

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!