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ICD-10 Guide
ICD-10 CodesA42.8

A42.8

Other forms of actinomycosis

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

Code Description

ICD-10 A42.8 is a billable code used to indicate a diagnosis of other forms of actinomycosis.

Key Diagnostic Point:

Actinomycosis is a chronic bacterial infection caused by Actinomyces species, which are anaerobic, gram-positive bacteria. While the most common form is cervicofacial actinomycosis, other forms can affect various body systems, including the thoracic, abdominal, and pelvic regions. In immunocompromised patients, such as those with HIV/AIDS, diabetes, or those undergoing chemotherapy, the risk of developing actinomycosis increases significantly. These patients may present with atypical symptoms, making diagnosis challenging. The clinical manifestations can range from abscess formation to systemic infections, often mimicking other conditions such as malignancies or tuberculosis. Diagnostic challenges arise due to the slow-growing nature of the bacteria and the need for specific culture techniques, as standard laboratory tests may not detect Actinomyces. Imaging studies, such as CT scans or MRIs, may be necessary to identify abscesses or other complications. Treatment typically involves prolonged antibiotic therapy, and in some cases, surgical intervention may be required to drain abscesses or remove necrotic tissue.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of clinical presentations depending on the affected body region.
  • Need for specific laboratory tests to confirm diagnosis.
  • Potential overlap with other infectious diseases in immunocompromised patients.
  • Documentation of patient history and risk factors is crucial for accurate coding.

Audit Risk Factors

  • Inadequate documentation of clinical findings and treatment plans.
  • Failure to specify the site of infection.
  • Misidentification of actinomycosis as a more common infection.
  • Lack of supporting laboratory results in the medical record.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, laboratory results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic abscesses or systemic infections, particularly in immunocompromised individuals.

Billing Considerations

Ensure that all relevant risk factors and comorbidities are documented to support the diagnosis.

Pulmonology

Documentation Requirements

Radiology reports, pulmonary function tests, and detailed patient history.

Common Clinical Scenarios

Patients with respiratory symptoms and imaging findings suggestive of thoracic actinomycosis.

Billing Considerations

Document any differential diagnoses considered, as thoracic actinomycosis can mimic other pulmonary conditions.

Coding Guidelines

Inclusion Criteria

Use A42.8 When
  • According to ICD
  • 10 coding guidelines, A42
  • 8 should be used when the specific form of actinomycosis is not classified elsewhere
  • Coders must ensure that the diagnosis is supported by clinical documentation and that other forms of actinomycosis are ruled out

Exclusion Criteria

Do NOT use A42.8 When
No specific exclusions found.

Related CPT Codes

87070CPT Code

Culture, bacterial, any other source

Clinical Scenario

Used when culturing for Actinomyces species.

Documentation Requirements

Document the source of the culture and any relevant clinical findings.

Specialty Considerations

Infectious disease specialists should ensure comprehensive documentation of the patient's history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of actinomycosis, enabling better tracking of this rare infection and its various forms. This specificity aids in research and improves patient care by allowing for targeted treatment strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of actinomycosis, enabling better tracking of this rare infection and its various forms. This specificity aids in research and improves patient care by allowing for targeted treatment strategies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of actinomycosis, enabling better tracking of this rare infection and its various forms. This specificity aids in research and improves patient care by allowing for targeted treatment strategies.

Resources

Clinical References

  • •
    CDC Actinomycosis Information

Coding & Billing References

  • •
    CDC Actinomycosis Information

Frequently Asked Questions

What are the common symptoms of actinomycosis?

Common symptoms include chronic abscess formation, pain at the site of infection, fever, and systemic symptoms such as weight loss and malaise. Symptoms can vary significantly based on the site of infection.