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v1.0.0
ICD-10 Guide
ICD-10 CodesA71.1

A71.1

Toxic shock syndrome

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

Code Description

ICD-10 A71.1 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 the rapid 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 occur as a rare complication, particularly in women with pelvic inflammatory disease (PID) or those using superabsorbent tampons. The respiratory manifestations may include pneumonia or acute respiratory distress syndrome (ARDS), while urogenital manifestations can involve severe pelvic pain, fever, and systemic symptoms due to the spread of infection. Diagnosis is primarily clinical, supported by laboratory findings, and requires prompt recognition and treatment to prevent severe complications or death. Management typically involves aggressive fluid resuscitation, antibiotic therapy, and supportive care in a hospital setting.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between TSS and other similar syndromes.
  • Understanding the specific bacterial etiology involved.
  • Recognizing the various clinical presentations across different patient populations.
  • Navigating the documentation requirements for associated conditions.

Audit Risk Factors

  • Inadequate documentation of the clinical criteria for TSS.
  • Failure to specify the underlying infection (e.g., chlamydia).
  • Misclassification of TSS as a less severe condition.
  • Lack of supporting lab results or imaging studies.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on the patient's history, presenting symptoms, and laboratory findings.

Common Clinical Scenarios

Patients presenting with fever, rash, and hypotension following a chlamydial infection.

Billing Considerations

Ensure clear documentation of the infectious source and any complications.

Emergency Medicine

Documentation Requirements

Immediate assessment notes, vital signs, and treatment interventions.

Common Clinical Scenarios

Patients arriving with acute symptoms suggestive of TSS.

Billing Considerations

Timely documentation of interventions and response to treatment is critical.

Coding Guidelines

Inclusion Criteria

Use A71.1 When
  • According to ICD
  • 10 coding guidelines, A71
  • 1 should be used when the clinical criteria for toxic shock syndrome are met, and there is a documented association with chlamydial infections

Exclusion Criteria

Do NOT use A71.1 When
  • Exclusion criteria include other causes of shock or infections that do not meet the TSS criteria

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with severe symptoms of TSS.

Documentation Requirements

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

Specialty Considerations

Emergency medicine specialists should document the urgency and severity of the condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of toxic shock syndrome, enabling better tracking of cases and associated complications. This specificity aids in research and improves patient care by highlighting the need for prompt diagnosis and treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of toxic shock syndrome, enabling better tracking of cases and associated complications. This specificity aids in research and improves patient care by highlighting the need for prompt diagnosis and treatment.

Reimbursement & Billing Impact

reimbursement.

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.