ICD-10 Guide

A08.1

Intestinal infection due to Clostridium difficile, unspecified

BILLABLE STATUSNo

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/04/2025

Code Description

ICD-10 A08.1 is a used to indicate a diagnosis of intestinal infection due to clostridium difficile, unspecified.

Key Diagnostic Point:

Conditions that use this ICD-10 code in their documentation

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

# Analysis of ICD-10 Code A08.1 - Intestinal Infection Due to Clostridium Difficile, Unspecified ## Complexity Rating **Medium** ## Factors Contributing to Complexity 1. **Clinical Presentation Variability**: - Symptoms of Clostridium difficile infection (CDI) can range from mild diarrhea to severe colitis, which may require clinical judgment to determine the appropriate diagnosis. - The unspecified nature of the code indicates that the clinician did not specify the severity or type of the infection, which can complicate clinical management and coding. 2. **Diagnostic Criteria**: - The diagnosis of CDI often requires laboratory confirmation (e.g., stool tests for toxins), and the decision to test may vary based on clinical guidelines, leading to variability in documentation. - The presence of other gastrointestinal diseases may complicate the diagnosis and necessitate differential diagnoses. 3. **Treatment Variability**: - Treatment approaches can vary significantly based on the severity of the infection and patient comorbidities, which may not always be well-documented in the medical record. - Changes in treatment protocols over time may also impact how a CDI case is handled and documented. 4. **Potential for Co-morbid Conditions**: - CDI can occur in patients with various underlying health conditions, such as immunocompromised states, which can influence coding and require additional codes for comorbidities. ## Audit Risks and Considerations 1. **Documentation Quality**: - Incomplete or vague documentation regarding the diagnosis of CDI can lead to improper coding and billing practices, increasing the risk of audits. - Lack of supporting documentation for severity (e.g., mild, moderate, or severe) can result in coding discrepancies. 2. **Unspecified Codes**: - The use of unspecified codes (e.g., A08.1) can raise red flags during audits since they may suggest a lack of thoroughness in documenting the clinical picture. - Auditors may look for more specific coding that reflects the clinician's intent and patient condition. 3. **Clinical Justification**: - Failure to provide clinical justification for the diagnosis and treatment plan can lead to challenges during audits, especially if the treatment appears to be more aggressive than what is typically warranted for an unspecified diagnosis. 4. **Frequency of CDI**: - Given the rising incidence of CDI in healthcare settings, payers may scrutinize these cases more closely, particularly in relation to hospital-acquired infections. ## Documentation Requirements 1. **Clinical Notes**: - Clear documentation of the patient's symptoms (e.g., diarrhea, abdominal pain) and the duration of these symptoms. - Any laboratory test results confirming the presence of Clostridium difficile toxins should be included. 2. **Assessment and Plan**: - Documentation should include a clear assessment of the severity of the infection and the rationale for the chosen treatment plan. - Any coexisting conditions that may impact treatment or outcomes should be documented clearly. 3. **Follow-up and Outcomes**: - Records should reflect any follow-up appointments, treatment responses, and changes in the clinical status of the patient. - If the patient has recurrent infections, this should be noted for proper coding and management. 4. **Compliance with Guidelines**: - Adherence to established clinical guidelines for diagnosing and managing CDI should be documented, along with the reasoning behind any deviations from standard protocols. By ensuring that all of the above factors are considered and adequately documented, healthcare providers can reduce the complexity associated with ICD-10 code A08.1, minimize audit risks, and enhance overall coding accuracy.

Audit Risk Factors

Specialty Focus

Medical Specialties

General

Documentation Requirements

Standard requirements apply

Common Clinical Scenarios

Various clinical presentations

Billing Considerations

Follow standard billing guidelines

Coding Guidelines

Inclusion Criteria

Use A08.1 When

10 Code A08
Intestinal Infection Due to Clostridium Difficile, Unspecified
Overview
10 code A08
1 is used to classify intestinal infections caused by Clostridium difficile, which is a bacterium that can cause inflammation of the colon (colitis) and is often associated with antibiotic use
This code is used when the specific details of the infection are not otherwise specified
When to Use A08
1 vs Related Codes

Exclusion Criteria

Do NOT use A08.1 When

Inclusion and Exclusion Criteria
Exclusion Criteria:

Related CPT Codes

No CPT Codes Available

Related CPT codes for this diagnosis will be displayed here when available.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Changes from ICD-9 to ICD-10

- In ICD-9, Clostridium difficile infection (CDI) was coded under 008.45. The ICD-9 code was broader and less specific.

ICD-9 vs ICD-10

The implementation of ICD-10 had a significant impact on the coding of diseases, including code A08.1, which pertains to "Intestinal infection due to Clostridium difficile, unspecified." Here’s a comprehensive overview of the changes and implications associated with this code. Changes from ICD-9 to ICD-10 1. Code Structure: - In ICD-9, Clostridium difficile infection (CDI) was coded under 008.45. The ICD-9 code was broader and less specific. - ICD-10 introduced A08.1, which allows for more detailed classification of intestinal infections, including those caused by Clostridium difficile. 2. Code Specificity: - ICD-10 codes are alphanumeric and allow for greater specificity. For instance, under ICD-10, healthcare providers can specify the nature of the infection, its severity, and other relevant clinical details, which were not as easily captured in ICD-9. Specificity Improvements - Enhanced Detail: ICD-10 provides the ability to document specific strains and manifestations of CDI, which can be critical for treatment decisions....

A08.1

Code Description

Key Diagnostic Point:

Code Complexity Analysis

Complexity Rating: Medium

Complexity Factors

Audit Risk Factors

Specialty Focus

Medical Specialties

General

Documentation Requirements

Common Clinical Scenarios

Billing Considerations

Coding Guidelines

Inclusion Criteria

Exclusion Criteria

Related CPT Codes

No CPT Codes Available

ICD-10 Impact

Diagnostic & Documentation Impact

ICD-10 Improvements

ICD-9 vs ICD-10

Reimbursement & Billing Impact

Resources

Clinical References

Coding & Billing References

Frequently Asked Questions

A08.1

Code Description

Key Diagnostic Point:

Code Complexity Analysis

Complexity Rating: Medium

Complexity Factors

Audit Risk Factors

Specialty Focus

Medical Specialties

General

Documentation Requirements

Common Clinical Scenarios

Billing Considerations

Coding Guidelines

Inclusion Criteria

Exclusion Criteria

Related CPT Codes

No CPT Codes Available

ICD-10 Impact

Diagnostic & Documentation Impact

ICD-10 Improvements

ICD-9 vs ICD-10

Reimbursement & Billing Impact

Resources

Clinical References

Coding & Billing References

Frequently Asked Questions