Professional Resources
Possible relevant C. difficile ICD-10 codes
Patients with Clostridium difficile–associated diarrhea may experience repeat episodes, and the risk of a recurrence increases with each episode.1 Twenty-five percent to 30% of patients develop recurrence within days or weeks of an initial infection.2 Recurrence is associated with greater morbidity, and practice guidelines provide distinct recommendations for the management of recurrence.2
These were some of the factors considered when the CDC recommended, and CMS adopted, these codes.3
The codes, now available for use, are4:
Possible relevant ICD-10 codes for DIFICID® (fidaxomicin)
Code | Diagnosis |
---|---|
A04.71 | Enterocolitis due to Clostridium difficile, recurrent |
A04.72 | Enterocolitis due to Clostridium difficile, not specified as recurrent |
Providers are now able to more easily identify patients who have had previous CDAD episodes, and can thus aid in decision-making about appropriate treatment options.
The above codes may be potentially relevant when billing for DIFICID and its administration. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of its use and for information on additional codes. Diagnosis codes should be selected only by a health care professional. Please consult with the applicable payer to understand the payer’s specific billing requirements. This information is subject to change.
You are solely responsible for determining the appropriate codes and for any action you take in billing. The information provided here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.
Definitions
CDAD = Clostridium difficile–associated diarrhea
CDC = Centers for Disease Control and Prevention
CMS = Centers for Medicare and Medicaid Services
References
1. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431–455. doi:10.1086/651706.
2. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Document CMS-1677-F. Published in the Federal Register August 14, 2017. https://federalregister.gov/d/2017-16434. Accessed September 29, 2017.
3. ICD-10 code lookup. Centers for Medicare and Medicaid Services website. https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-codelookup.aspx?KeyWord=clostridium%20difficile&bc=AAAAAAAAAAAQAA%3d%3d&. Accessed September 29, 2017.
4. Clostridium difficile. ICD-10 coordination and maintenance committee meeting. Centers for Disease Control and Prevention. March 9–10, 2016.