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v1.0.0
ICD-10 Guide
ICD-10 CodesA36

A36

Diphtheria

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 A36 is a billable code used to indicate a diagnosis of diphtheria.

Key Diagnostic Point:

Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae, which primarily affects the mucous membranes of the throat and nose. The disease is characterized by the formation of a thick, gray membrane in the throat that can obstruct breathing and swallowing. Symptoms typically include sore throat, fever, swollen lymph nodes, and malaise. Diphtheria can lead to severe complications such as myocarditis, neuropathy, and respiratory failure if not treated promptly. The infection is transmitted through respiratory droplets or contact with contaminated surfaces. Vaccination with the diphtheria toxoid is the most effective preventive measure, and treatment usually involves the administration of diphtheria antitoxin and antibiotics such as penicillin or erythromycin. Early diagnosis and intervention are crucial to prevent serious outcomes, especially in unvaccinated populations. Resistance patterns are generally low for the antibiotics used, but vigilance is necessary due to the potential for emerging resistance.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between diphtheria and other upper respiratory infections
  • Documentation of vaccination history and exposure
  • Understanding of the various clinical presentations
  • Need for accurate coding of complications

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document vaccination status
  • Misclassification of the type of diphtheria (cutaneous vs. respiratory)
  • Lack of detail regarding treatment protocols

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, exposure history, and treatment response.

Common Clinical Scenarios

Diagnosis and management of diphtheria in unvaccinated patients or outbreaks.

Billing Considerations

Consideration of antibiotic resistance patterns and patient history.

Pediatrics

Documentation Requirements

Vaccination history, clinical presentation, and family history of infectious diseases.

Common Clinical Scenarios

Management of diphtheria in children, especially in areas with low vaccination rates.

Billing Considerations

Focus on preventive measures and education regarding vaccination.

Coding Guidelines

Inclusion Criteria

Use A36 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, treatment, and any complications
  • Include details on vaccination status and exposure history

Exclusion Criteria

Do NOT use A36 When
No specific exclusions found.

Related Codes

Child Codes

13 codes
A36.0
Meningococcal meningitis, group A
A36.1
Erysipeloid
A36.2
Meningococcal meningitis, unspecified
A36.3
Meningococcal endocarditis
A36.8
Other specified tetanus
A36.81
Diphtheritic cardiomyopathy
A36.82
Diphtheritic radiculomyelitis
A36.83
Diphtheritic polyneuritis
A36.84
Diphtheritic tubulo-interstitial nephropathy
A36.85
Diphtheritic cystitis
A36.86
Diphtheritic conjunctivitis
A36.89
Other diphtheritic complications
A36.9
Meningococcal meningitis, unspecified

Related CPT Codes

90375CPT Code

Diphtheria toxoid vaccine administration

Clinical Scenario

Administering the diphtheria vaccine to prevent infection.

Documentation Requirements

Record vaccine type, dosage, and patient consent.

Specialty Considerations

Pediatricians should emphasize vaccination schedules.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diphtheria, enabling better tracking of cases and complications, which can improve public health responses and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diphtheria, enabling better tracking of cases and complications, which can improve public health responses and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diphtheria, enabling better tracking of cases and complications, which can improve public health responses and resource allocation.

Resources

Clinical References

  • •
    CDC Diphtheria Information

Coding & Billing References

  • •
    CDC Diphtheria Information

Frequently Asked Questions

What are the common symptoms of diphtheria?

Common symptoms include a sore throat, fever, swollen lymph nodes, and the presence of a thick gray membrane in the throat.

How is diphtheria treated?

Treatment typically involves the administration of diphtheria antitoxin and antibiotics such as penicillin or erythromycin.

Is diphtheria preventable?

Yes, diphtheria is preventable through vaccination with the diphtheria toxoid.