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ICD-10 Guide
ICD-10 CodesR85.5

R85.5

Abnormal microbiological findings in specimens from digestive organs and abdominal cavity

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R85.5 is a billable code used to indicate a diagnosis of abnormal microbiological findings in specimens from digestive organs and abdominal cavity.

Key Diagnostic Point:

R85.5 is used to classify abnormal microbiological findings in specimens obtained from the digestive organs and abdominal cavity. This code encompasses a range of findings that may indicate the presence of pathogenic microorganisms, such as bacteria, viruses, fungi, or parasites, that are not classified elsewhere. Common symptoms associated with these findings may include abdominal pain, diarrhea, nausea, vomiting, and fever. The abnormal findings can arise from various diagnostic tests, including stool cultures, blood cultures, and biopsies of gastrointestinal tissues. Clinicians may order these tests when patients present with gastrointestinal symptoms or systemic signs of infection. The interpretation of microbiological findings requires careful consideration of the clinical context, as not all detected microorganisms indicate disease. For instance, some may be part of the normal flora or may not be pathogenic in the given clinical scenario. Accurate coding necessitates thorough documentation of the clinical findings, the specific tests performed, and the interpretation of results.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential microorganisms that can be identified
  • Need for clinical correlation to determine pathogenicity
  • Differentiation from normal flora findings
  • Variability in laboratory reporting formats

Audit Risk Factors

  • Inadequate documentation of clinical correlation
  • Misinterpretation of laboratory results
  • Failure to specify the type of specimen collected
  • Coding based solely on laboratory findings without clinical context

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Documentation must include clinical symptoms, test results, and the physician's interpretation of findings.

Common Clinical Scenarios

Patients presenting with unexplained abdominal pain, diarrhea, or fever where microbiological testing is warranted.

Billing Considerations

Consideration of the patient's history and risk factors for infections, such as recent travel or antibiotic use.

Emergency Medicine

Documentation Requirements

Acute care documentation should detail the presenting symptoms, tests ordered, and immediate clinical findings.

Common Clinical Scenarios

Patients with acute abdominal pain and signs of sepsis requiring rapid microbiological assessment.

Billing Considerations

Rapid identification of potential pathogens is critical; documentation must reflect urgency and rationale for testing.

Coding Guidelines

Inclusion Criteria

Use R85.5 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the code is used only when there is clear documentation of abnormal microbiological findings related to digestive organs or the abdominal cavity

Exclusion Criteria

Do NOT use R85.5 When
No specific exclusions found.

Related CPT Codes

87070CPT Code

Culture, bacterial, any source

Clinical Scenario

Used when a stool culture is performed to identify pathogens.

Documentation Requirements

Document the type of specimen, clinical indications for the test, and results.

Specialty Considerations

In infectious disease specialties, ensure correlation with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abnormal microbiological findings, improving the granularity of data for epidemiological studies and healthcare analytics.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abnormal microbiological findings, improving the granularity of data for epidemiological studies and healthcare analytics.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of abnormal microbiological findings, improving the granularity of data for epidemiological studies and healthcare analytics.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What types of specimens are included under R85.5?

R85.5 includes specimens from stool, blood, and biopsies from the digestive organs and abdominal cavity that show abnormal microbiological findings.