Chapter 1:Certain infectious and parasitic diseases
BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED08/28/2025
Code Description
ICD-10 A21 is a used to indicate a diagnosis of tularemia.
Key Diagnostic Point:
Tularemia
Tularemia
Code Complexity Analysis
Complexity Rating: High
High Complexity
Rating: Medium to High
Factors:
1. Specificity: ICD-10 Code A21 Non-billable, which pertains to Tularemia, is a general or 'parent' code. It is divided into several more specific sub-codes which add detail to the diagnosis. The usage of such nonspecific codes can lead to miscoding or undercoding, and can generate audit triggers if used frequently.
2. Diverse Variants: Mapped to several specific variants like A21.0 for Ulceroglandular tularemia, A21.1 for Oculoglandular tularemia, A21.2 for Pulmonary tularemia, and so on. It is essential to code to the highest level of specificity for accurate coding, data capture, and reimbursement.
3. Depth of Knowledge: Requires understanding of the disease condition and its variants for correct coding.
Audit Risks:
1. Improper Coding: The risk of improper coding is high for ICD-10 Code A21 Non-billable. The right sub-code may be missed if the coder lacks detailed understanding of the condition.
2. Incorrect Reimbursement: Usage of the parent code A21 could lead to inaccurate reimbursement claims. It might not reflect the complexity and severity of the patient’s actual condition leading to revenue loss.
3. Compliance Issues: Consistent use of non-specific codes like A21 may trigger compliance reviews or audits due to non-adherence to coding standards.
4. Quality of Care Analysis: The inaccurate use of this medium to high complexity code can impact healthcare statistics and quality of care analyses. It could reflect inaccurate epidemiological data at a macro level if not correctly coded.
5. Documentation: Adequate and accurate documentation supporting the use of a specific code is vital. Lack of sufficient documentation is a common reason for audit failures.
Overall the complexity of ICD-10 Code A21 Non-billable arises from its nonspecific nature and the requirement for a deep understanding of the disease condition for correct coding. Combined with the potential for the audit risks outlined, this poses challenges for accurate and compliant use in medical coding.
Specialty Focus
Coding Guidelines
Inclusion Criteria
Use A21 When
The ICD
10 code A21, also known as "Tularemia" is classified as non
billable, meaning that it cannot necessarily be used for reimbursement purposes
Since there are specific codes relating to various manifestations of Tularemia, coders often must employ more specific codes when documenting this condition
Here are some crucial points to consider while applying this code:
10 Code
A21, as mentioned, refers to Tularemia
a disease that typically manifests in various forms, like ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic, typhoidal, and septic
Exclusion Criteria
Do NOT use A21 When
Inclusion and Exclusion Criteria: The ICD
Each form of Tularemia typically has its inclusions and exclusions which must be consulted while coding
Related CPT Codes
The ICD-10 code A21 is non-billable and is used for diagnosis and management of tularemia, a rare infectious disease caused by the bacterium Francisella tularensis. Common procedures related to this diagnosis might include diagnostic testing, medication management or infectious disease consultation.
However, please note that it's difficult to provide exact CPT codes as it would vary based on each patient's condition, the procedures performed by the healthcare provider and other factors. Here are general CPT codes that might be commonly used in this context:
1. CPT Code 99213: Office or other outpatient visit for the evaluation and management of an established patient. Clinical scenario: A patient comes for a follow-up visit after being diagnosed with tularemia.
2. CPT Code 99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of three key components. Clinical scenario: A patient with known tularemia comes to the office with complaints of persistent fever and fatigue.
3. CPT Code 36415: Collection of venous blood by venipuncture. Clinical scenario: Blood tests are needed to confirm the presence of tularemia bacteria.
4. CPT Code 71045: Chest X-ray to check for pneumonia or enlargement of the mediastinum, which might be secondary to tularemia. Clinical scenario: A patient diagnosed with tularemia presents with respiratory symptoms, so an X-ray is performed to rule out complications.
5. CPT Code 99232: Subsequent hospital care, per day, for the evaluation and management of a patient. Clinical scenario: An inpatient with severe tularemia requires daily evaluations to monitor the disease progression.
6. CPT Code 99223: Initial hospital care, for the evaluation and management of a patient, which requires these 3 key components. Clinical scenario: A patient with severe symptoms is hospitalized and needs comprehensive management.
7. CPT Code 90715: Tdap vaccine (against tetanus, diphtheria, and pertussis [whooping cough]), because these patients are often at higher risk of secondary infections. Clinical scenario: A patient diagnosed with tularemia needs preventative care against additional infections.
Remember, the listed CPT codes are merely representative examples and are not definitive - the specific CPT codes used will differ based on each patient's specific circumstances.
ICD-10 Impact
Diagnostic & Documentation Impact
Enhanced Specificity
ICD-10 Improvements
The International Classification of Diseases, Tenth Revision (ICD-10) is a system used by healthcare providers to code and categorize diseases and health issues. The transition from ICD-9 to ICD-10 expanded the coding system, improving the ability to capture and track detailed health information. When it comes to coding for A21 (Non-billable), it primarily impacts specificity, reimbursement, and documentation.
1. Specificity: ICD-10 increased the specificity of coding for conditions such as A21. More accurate coding allows for better tracking and management of diseases, conditions, and health issues. The granularity in ICD-10 not only more accurately reflects a patient's medical condition but also enhances data for research, public health surveillance, quality measurement, and healthcare reimbursement.
2. Reimbursement: With the increased specificity comes changes in reimbursement. With the ICD-10 code A21, it allows for more precision and detail, which can lead to more appropriate payment for services rendered. However, incorrect or non-specific coding could lead to payment denials or delays. As "A21" is categorized as non-billable, those codes are not sufficient justification for admitting to an acute care hospital when used a principal diagnosis.
ICD-9 vs ICD-10
The International Classification of Diseases, Tenth Revision (ICD-10) is a system used by healthcare providers to code and categorize diseases and health issues. The transition from ICD-9 to ICD-10 expanded the coding system, improving the ability to capture and track detailed health information. When it comes to coding for A21 (Non-billable), it primarily impacts specificity, reimbursement, and documentation. 1. Specificity: ICD-10 increased the specificity of coding for conditions such as A21. More accurate coding allows for better tracking and management of diseases, conditions, and health issues. The granularity in ICD-10 not only more accurately reflects a patient's medical condition but also enhances data for research, public health surveillance, quality measurement, and healthcare reimbursement. 2. Reimbursement: With the increased specificity comes changes in reimbursement. With the ICD-10 code A21, it allows for more precision and detail, which can lead to more appropriate payment for services rendered. However, incorrect or non-specific coding...
Reimbursement & Billing Impact
reimbursement, and documentation.
Resources
Clinical References
1. World Health Organization (WHO): The WHO maintains the International Classification of Diseases (ICD) system, making it a primary source for understanding the design and purpose of ICD-10 codes.
2. Centers for Disease Control and Prevention (CDC): On the CDC website, you will find the National Center for Health Statistics, which provides details on revisions of the ICD and their US Clinical Modification (ICD-10-CM).
3. American Medical Association (AMA): The AMA provides guides and resources for healthcare professionals, including details on how to properly use ICD-10 codes.
4. ICD10Data.com: This is an advanced but comprehensive online reference tool providing the complete ICD-10-CM and Procedure Coding System.
5. American Health Information Management Association (AHIMA): AHIMA offers training and resources related to health information management, including coding and the use of ICD-10 codes.
6. American Academy of Professional Coders (AAPC): AAPC provides training and certification for medical coders, making it a useful resource for understanding ICD-10 codes.
7. FindACode.com: This is an online coding and billing resource that also includes a searchable database of ICD-10 codes.
Coding & Billing References
1. World Health Organization (WHO): The WHO maintains the International Classification of Diseases (ICD) system, making it a primary source for understanding the design and purpose of ICD-10 codes.
2. Centers for Disease Control and Prevention (CDC): On the CDC website, you will find the National Center for Health Statistics, which provides details on revisions of the ICD and their US Clinical Modification (ICD-10-CM).
3. American Medical Association (AMA): The AMA provides guides and resources for healthcare professionals, including details on how to properly use ICD-10 codes.
4. ICD10Data.com: This is an advanced but comprehensive online reference tool providing the complete ICD-10-CM and Procedure Coding System.
5. American Health Information Management Association (AHIMA): AHIMA offers training and resources related to health information management, including coding and the use of ICD-10 codes.
6. American Academy of Professional Coders (AAPC): AAPC provides training and certification for medical coders, making it a useful resource for understanding ICD-10 codes.
7. FindACode.com: This is an online coding and billing resource that also includes a searchable database of ICD-10 codes.
