A notorious superbug, Clostridium difficile or C-diff affects about half a million people in America every year. This hospital acquired infection (HAC) can range from mild to life-threatening, and is costly and challenging to treat and manage. As experienced coders in a medical billing and coding companies know, proper reimbursement depends on diagnosing, documenting, treating, and coding superbug infections correctly and as early as possible.
Physicians in a Canadian hospital now have a canine assistant to help them identify c-diffcile. The Guardian recently reported on this two-year-old English springer spaniel called Angus that is specially trained to sniff out C difficile in hospitalized patients. The dog has been roped in to work with Vancouver Coastal Health, the health authority that oversees the city’s general hospital. Hospitals generally use ultraviolet light to find the bacteria, but Angus can do the job more quickly and efficiently.
The dog was trained using cotton swabs with the scent of C difficile which researchers isolated from the bug. After he moves through the room and detects the bacteria, an ultraviolet light enabled robot is used to clean the area and disinfect 99.9% of the C difficile spores.
C. difficile infections have become more frequent, life-threatening, and challenging to treat in recent years. Symptoms include diarrhea several times a day, fever, abdominal pain, loss of appetite, blood or pus in the stool, and weight loss. According to a study published in the American Journal of Infection Control, c. diff was responsible for an increase in hospital costs of about 40 percent per case. The study found that costs were even higher for patients who contracted renal impairment, immunocompromised status, and concomitant antibiotic exposure.
With high costs and risk factors for contamination, it is critical that superbug infections are correctly identified, coded, and tracked on a nationwide basis. ICD10monitor reports that the nuances of coding bacterial infections related to antibiotic-resistant superbugs can have a significant impact on hospital revenue streams. Effective Oct. 1, 2016, the 2017 updates include codes for c. diff and Methicillin-resistant Staphylococcus aureus (MRSA) as HACs.
The 2017 ICD-10-CM diagnosis code for Enterocolitis due to clostridium difficile is A04.7. This is the billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. It is applicable to:
- Foodborne intoxication by Clostridium difficile
- Pseudomembraneous colitis
Terms related to clostridium difficile include: colitis, diarrehea, enteritis, enterocolitis, clostridium NEC and Megacolon (acquired) (functional).
ICD-10 also has codes for 22 different types of medication and codes for resistance to medication which makes patient cases more difficult and costly to treat. Though the medication resistance codes do not impact the diagnosis-related group (DRG), they are usually high-revenue cases with long lengths of stays. Z codes are resistance codes.
To code correctly, c.diff Foundation recommends the following steps:
- Identifying the infection/type of bacteria
- Assigning a Z code to depict the resistance
- Assigning an appropriate code if the patient has been taking a lot of antibiotics
Experienced coders in a reliable medical billing and coding company assign the codes for superbug infections only after thoroughly reviewing all supporting documentation including culture reports, physician progress notes, medication administration records, and any other ancillary testing used to identify and code resistance.
Angus’ unique ability has attracted global attention, with healthcare providers hoping that this will open the doors to controlling the superbug crisis. And it’s not the first time that a dog has lived up to its reputation as man’s best friend. In July last year, researchers found that dogs can sniff out diabetes.