Chapter 1:Certain infectious and parasitic diseases
BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED08/28/2025
Code Description
ICD-10 A20 is a used to indicate a diagnosis of "plague due to yersinia pestis".
Key Diagnostic Point:
Brucellosis
Code Complexity Analysis
Complexity Rating: High
High Complexity
The ICD-10 Code A20 is a non-billable code, indicating Plague. Any code classified as "non-billable" means it must not be used on a reimbursement claim. There are 11 codes underneath A20 that describes specific diagnosis.
Rating:
Given that the ICD-10 Code A20 requires further specificity, it holds a relatively high complexity rating. This is mainly because the use of this preliminary code requires further investigation to identify the appropriate billable subcodes.
Factors:
1. Specificity: The A20 code alone is broad and could lead to a range of precise diagnoses. There are 11 different subcodes under A20 that define more particularly what the patient's situation is.
2. Training: Implementation of A20 ICD-10 code, like all other codes, necessitates intensive training for coders and physicians to ensure that they understand how to employ it correctly.
3. Documentation: To assign an A20 billable subcode, the medical documentation should be accurate and comprehensive. Any instance of missing or inconsistent data could prohibit proper classification.
Audit Risks:
The main risks come from the potential for improper coding. These risks can include:
1. Incorrect Billing: As the A20 non-billable code needs further detail, improper or no application of billable subcodes can lead to wrongful billing.
2. Compliance Issues: The complexity of A20 ICD-10 code, like any other medical codes, can increase the risk of code misuse, potentially leading to compliance issues with billing and reimbursement regulations.
3. Audit risk: If level of care, procedures, or diagnoses are not appropriately documented and coded, the healthcare provider risks negative external audit findings and potential penalties or reimbursement takebacks.
In conclusion, while the A20 code might seem simple enough on the surface, it carries a significant amount of complexity due to the factors like specificity, extensive documentation needed, training, and its implications on audit risk. These complexities become even more crucial and require proper attention to ensure efficient and accurate medical coding and billing.
Specialty Focus
Medical Specialties
ICD-10 code A20 is related to Plague, which is a serious bacterial infection that's transmitted by fleas. It is not often seen in most parts of the world today but is categorized as a non-billable code since it is not specific enough for a physician to use for billing purposes. Here are three medical specialties that may have relevance to ICD-10 code A20 based on its description:
1. Infectious Disease - An infectious disease specialist might see a patient presenting with symptoms of A20. A case scenario could be a patient who was recently traveling in an area where plague-infected animals were reported and has now developed high fever, weakness, and swollen lymph nodes.
2. Emergency Medicine - An emergency medicine doctor could encounter a patient in urgent need due to a possible plague infection. Clinical scenario might include a patient rushing in with sudden onset fever, chills, weakness, and a painful, swollen lymph node which is often a symptom of bubonic plague.
3. Internal Medicine - An internist might see a patient for follow-up on symptoms related to A20. A case could be an adult patient complaining about severe coughing, difficulty breathing and bloody sputum that can be a sign of pneumonic plague.
Please note, this is a hypothetical situation since Plague involves public health measures and is rare in many parts of the world. For further diagnosis and treatment of this disease, healthcare providers usually coordinate with public health departments and involve infectious disease specialists. In some places, this may be under the purview of public health and preventive medicine physicians or healthcare providers that specialize in tropical diseases.
Coding Guidelines
Inclusion Criteria
Use A20 When
The ICD
10 code A20 is not actually a billable or specific code
It is used to indicate a diagnosis for reimbursement purposes but must be used along with additional codes that provide more detail about the disease or condition
Broadly, the A20 category covers Plague
In more detail, it would have:
Bubonic plague
Cellulitis and cutaneous abscess of lymph nodes
Pneumonic plague
Exclusion Criteria
Do NOT use A20 When
Exclusion Criteria: Any conditions or diseases not specifically referred to by category A20 are not included under the use of this code
Related CPT Codes
As an AI developed by OpenAI, I must point out that the ICD-10 code A20 refers to Plague, including different forms of it such as bubonic, cellulosae, pneumonic, and septicemic and it's not specifically non-billable. The CPT (Current Procedural Terminology) codes are used to correctly describe the procedures displayed by a physician during the course of treatment. Here are some services and procedures that might accompany an ICD-10 diagnosis code A20.
Please note that the pairing of CPT and ICD-10 codes is dependent on various factors, including the patient's condition, the services actually provided, and payer rules.
1. CPT code 99282: Emergency department visit. This might be the first code billed when a patient presents symptoms and is admitted to the emergency department.
2. CPT code 87040: Blood culture for bacteria, aerobic. In case of suspected septicemic plague, a blood culture may be conducted to check the presence of bacteria.
3. CPT code 87207: Smear, primary source with interpretation; complex special stain (eg, trichrome, iron). This testing might be used for diagnostic purposes to check for bacterial presence affecting the tissues.
4. CPT code 99284: Emergency department visit. This code might be used if the patient has moderate severity illness and the physician needs to take immediate action.
5. CPT code 99223: Initial hospital care. In the event that the patient needs to be admitted for further treatment due to plague symptoms, this code could be billed.
6. CPT code 90765: Intravenous infusion, for therapy, prophylaxis, or diagnosis; it would be used if the patient was receiving ongoing intravenous antibiotic treatment.
7. CPT code 36556: Insertion of non-tunnelled centrally inserted central venous catheter. This could be required for intensive therapeutic interventions or for administering antibiotics.
It must be noted that these are potential correspondences and whether these are appropriate or not will depend largely on the exact manifestation of the disease and procedures performed. Before performing and billing any procedures, a provider should always ensure that it's necessary and proper documentation has been maintained.
ICD-10 Impact
Diagnostic & Documentation Impact
Enhanced Specificity
ICD-10 Improvements
The transition from ICD-9 to ICD-10 in the United States in 2015 brought about significant changes in medical coding, aimed at increasing specificity and detail. A20 in ICD-10 refers to Bacterial and viral infectious agents, which is non-billable.
Specificity: With the advent of ICD-10, diagnosis coding has become more specific, which has led to improved patient care quality by allowing a more accurate reflection of patients' health conditions. For A20, under ICD-10, a more specific code is required, meaning that additional characters must be added to identify the specific type of bacterial or viral agent.
Reimbursement: The non-billable nature of A20 in ICD-10 requirements means that, in its root form, it cannot be used for reimbursement purposes. Instead, specific extensions must be added to the code for it to be valid for reimbursement, highlighting the disease or condition's specifics and severity caused by the particular bacterial or viral agent. This can lead to more accurate reimbursement by ensuring that the code reflects the resources expended in treating the patient’s condition.
ICD-9 vs ICD-10
The transition from ICD-9 to ICD-10 in the United States in 2015 brought about significant changes in medical coding, aimed at increasing specificity and detail. A20 in ICD-10 refers to Bacterial and viral infectious agents, which is non-billable. Specificity: With the advent of ICD-10, diagnosis coding has become more specific, which has led to improved patient care quality by allowing a more accurate reflection of patients' health conditions. For A20, under ICD-10, a more specific code is required, meaning that additional characters must be added to identify the specific type of bacterial or viral agent. Reimbursement: The non-billable nature of A20 in ICD-10 requirements means that, in its root form, it cannot be used for reimbursement purposes. Instead, specific extensions must be added to the code for it to be valid for reimbursement, highlighting the disease or condition's specifics and severity caused by the particular bacterial or viral agent. This...
Reimbursement & Billing Impact
Reimbursement: The non-billable nature of A20 in ICD-10 requirements means that, in its root form, it cannot be used for reimbursement purposes. Instead, specific extensions must be added to the code for it to be valid for reimbursement, highlighting the disease or condition's specifics and severity caused by the particular bacterial or viral agent. This can lead to more accurate reimbursement by ensuring that the code reflects the resources expended in treating the patient’s condition.
Resources
Clinical References
1. Centers for Disease Control and Prevention (CDC) - ICD-10 Code Search: This website provides the complete list of ICD-10 codes, including A20, along with a comprehensive explanation for each code.
2. World Health Organization (WHO) - International Classification of Diseases (ICD): WHO is the official source of ICD codes, which provide a system of diagnostic codes for classifying diseases.
3. American Hospital Association (AHA) - Coding Clinic: AHA's coding clinic serves as a reference for health information management professionals in the application of ICD-10 and other coding systems.
4. American Health Information Management Association (AHIMA): It provides guidance and resources for coding and health information management professionals. Its coding-focused resources include the ICD-10-CM and ICD-10-PCS Codebooks.
5. American Medical Association (AMA) - ICD-10 Coding Resources: AMA's ICD-10 resources provide guidance and updates on utilizing the ICD-10 code system accurately and efficiently.
6. Centers for Medicare & Medicaid Services (CMS) – ICD-10: The CMS page on ICD-10 provides guidance, resources and updates about the use of ICD-10 in the Healthcare industry.
7. ICD10Data.com: This website provides a free reference including the full list of ICD-10 codes, tools for coding and information about changes and updates in the system.
Coding & Billing References
1. Centers for Disease Control and Prevention (CDC) - ICD-10 Code Search: This website provides the complete list of ICD-10 codes, including A20, along with a comprehensive explanation for each code.
2. World Health Organization (WHO) - International Classification of Diseases (ICD): WHO is the official source of ICD codes, which provide a system of diagnostic codes for classifying diseases.
3. American Hospital Association (AHA) - Coding Clinic: AHA's coding clinic serves as a reference for health information management professionals in the application of ICD-10 and other coding systems.
4. American Health Information Management Association (AHIMA): It provides guidance and resources for coding and health information management professionals. Its coding-focused resources include the ICD-10-CM and ICD-10-PCS Codebooks.
5. American Medical Association (AMA) - ICD-10 Coding Resources: AMA's ICD-10 resources provide guidance and updates on utilizing the ICD-10 code system accurately and efficiently.
6. Centers for Medicare & Medicaid Services (CMS) – ICD-10: The CMS page on ICD-10 provides guidance, resources and updates about the use of ICD-10 in the Healthcare industry.
7. ICD10Data.com: This website provides a free reference including the full list of ICD-10 codes, tools for coding and information about changes and updates in the system.
Frequently Asked Questions
1. Question: What does the ICD-10 code A20 (Non-billable) represent?
Answer: The ICD-10 code A20 represents bubonic plague, an infectious disease usually caused by the bacteria Yersinia pestis. Note that when classified as non-billable, it is usually an unspecified code that requires additional coding to provide a more complete paper trail for patient's medical history.
2. Question: What should be documented for a patient diagnosed with the bubonic plague, or ICD-10 code A20?
Answer: Documentation should detail the patient’s symptoms, the results of their medical examination, and any relevant medical history. Any performed treatment and the patient’s response to the treatment should also be documented. For more precise coding, note the presence of any complications related to bubonic plague.
3. Question: When should I use ICD-10 code A20 for billing purposes?
Answer: As ICD-10 code A20 is non-billable, it typically cannot be used for reimbursement purposes. To utilize for billing or reimbursement, it requires additional character(s) to create a billable code. Consult the ICD-10-CM Manual for more specific codes linked to ICD-10 A20 to ensure justified billing.
4. Question: Can ICD-10 code A20 be used as a standalone code?
Answer: No, ICD-10 code A20 is a non-billable code. To provide a complete diagnosis, you will need to follow the ICD-10 coding guidelines to add additional characters to describe the condition appropriately and specifically.
5. Question: What code relationships exist with ICD-10 code A20?
Answer: The ICD-10 code A20 is a grouping code for a range of more specific codes that represent different forms or complications of bubonic plague including bubonic plague with pneumonia, bubonic plague with septicemia, and unspecified forms. These specific forms of bubonic plague have their unique billable codes.
6. Question: How do these code relationships work with the billing process?
Answer: When billing, you use the specific and description-carrying billable codes rather than the general, non-billable code A20. These more specific codes not only help to justify the medical charges but also provide detailed information for tracking patient outcomes and public health statistics.
7. Question: Is it necessary to have specific documentation for the subtype codes of A20?
Answer: Yes, it is very necessary. For any of the specific billable codes under A20, detailed documentation is needed to justify the specific code used. This detailed documentation should include specifics about the diagnosis, treatments, medications, response to treatment, and any relevant medical history.
