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v1.0.0
ICD-10 Guide
ICD-10 CodesA71.0

A71.0

Toxic shock syndrome

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

Code Description

ICD-10 A71.0 is a billable code used to indicate a diagnosis of toxic shock syndrome.

Key Diagnostic Point:

Toxic shock syndrome (TSS) is a severe and potentially life-threatening condition characterized by sudden onset of fever, rash, hypotension, and multi-organ dysfunction. It is often associated with the presence of certain bacterial infections, particularly those caused by Staphylococcus aureus or Streptococcus pyogenes. In the context of chlamydial infections, TSS can manifest as a complication of severe pelvic inflammatory disease (PID) or other urogenital infections. Respiratory manifestations may include pneumonia or acute respiratory distress syndrome (ARDS), while urogenital manifestations can involve severe pain, discharge, and systemic symptoms. The syndrome is marked by the release of toxins into the bloodstream, leading to a hyper-inflammatory response. Diagnosis is primarily clinical, supported by laboratory findings, and requires prompt recognition and treatment to prevent severe complications or death. Management typically involves antibiotic therapy, fluid resuscitation, and supportive care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of presenting symptoms that can mimic other conditions
  • Need for comprehensive clinical documentation to support diagnosis
  • Potential for multiple underlying infections complicating the clinical picture
  • Variability in coding practices across specialties

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to link TSS to the underlying infection
  • Misclassification of the severity of the condition
  • Inconsistent coding practices across different healthcare providers

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on infection type, symptoms, and treatment response.

Common Clinical Scenarios

Patients presenting with severe systemic infections, often with a history of chlamydial infections.

Billing Considerations

Ensure all relevant lab results and imaging studies are documented to support the diagnosis.

Emergency Medicine

Documentation Requirements

Immediate assessment notes, vital signs, and treatment interventions.

Common Clinical Scenarios

Patients presenting with acute febrile illness and signs of shock.

Billing Considerations

Rapid documentation of clinical findings is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use A71.0 When
  • Follow the official ICD
  • CM guidelines for coding infectious diseases, ensuring accurate documentation of the underlying cause and any associated conditions
  • TSS should be coded only when the clinical criteria are met

Exclusion Criteria

Do NOT use A71.0 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with TSS symptoms requiring immediate care.

Documentation Requirements

Detailed notes on presenting symptoms, vital signs, and treatment provided.

Specialty Considerations

Emergency medicine specialists should ensure rapid documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like TSS, improving the accuracy of data collection and reimbursement processes. It has also highlighted the need for detailed documentation to support complex diagnoses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like TSS, improving the accuracy of data collection and reimbursement processes. It has also highlighted the need for detailed documentation to support complex diagnoses.

Reimbursement & Billing Impact

reimbursement processes. It has also highlighted the need for detailed documentation to support complex diagnoses.

Resources

Clinical References

  • •
    CDC Guidelines on Toxic Shock Syndrome

Coding & Billing References

  • •
    CDC Guidelines on Toxic Shock Syndrome

Frequently Asked Questions

What are the common symptoms of toxic shock syndrome?

Common symptoms include sudden high fever, rash, low blood pressure, confusion, and multi-organ dysfunction. Patients may also present with gastrointestinal symptoms and signs of infection.