Foodborne illnesses or food poisoning is usually caused by eating raw or uncooked food. According to the Centers for Disease Control and Prevention (CDC), one in six Americans will be affected by foodborne illnesses each year. Food poisoning peaks in the summer and medical billing and coding companies report that they process a large number of medical claims of patients being for these conditions. In July, a salmonella outbreak hit several states. The Centers for Disease Control and Prevention (CDC), public health officials, and the U.S. Food and Drug Administration (FDA) are investigating this outbreak of Salmonella Kiambu infections which are linked to papaya. Salmonella infection may spread from the intestines to the bloodstream and then to other places in the body.
On July 21, the CDC reported that a total of 47 people had been infected with the outbreak strain of Salmonella Kiambu in 12 states and that one death occurred in New York City. In Maryland, an illness cluster was identified. Epidemiologic and laboratory evidence point to yellow Maradol papayas as the possible source of this multistate outbreak. Bas the investigation progresses, the CDC has advised people not to eat yellow Maradol papayas, and recommended that restaurants and retailers refrain from serving/selling the fruit.
Salmonella poisoning generally causes nausea, vomiting, diarrhea, abdominal pain and fever. In the recently reported case, most people affected by the salmonella infection developed the following symptoms:
- Abdominal cramps
Salmonella infection usually lasts 4-7 days, with most people recovering without treatment. People with severe symptoms may need to be hospitalized, though death can occur if the salmonella infection is not quickly treated with antibiotics. Children younger than 5 years, adults older than 65, and people with weakened immune systems are most likely to be affected.
Patients may have several symptoms or only one, and the history is the most important step in assessing a patient with diarrhea. Physicians also evaluate epidemiologic features and objective findings to make an accurate diagnosis.
ICD-10 provides for increased specificity in reporting foodborne illnesses, allowing for a more precise description of a patient’s disease or condition than ICD-9. With improved morbidity data, it is easier to identify and track existing and new health threats.
Intestinal infectious diseases are classified in the code block A00 to A09 in ICD-10. Category A08 provides the classification of viral intestinal infections and the common bacterial intestinal infections are classified to category A04. An article in ICD-10 Monitor provides the following examples of common foodborne intestinal infections caused by bacteria which are reported in categories A00-A04:
- A02.0 Salmonella enteritis
- A03.0 Shigellosis due to Shigella dysenteriae
- A04.0 Enteropathogenic Escherichia coli infection
- A04.5 Campylobacter enteritis
Parasites are another cause of foodborne intestinal infections and these codes are listed in categories A06-A07. Common intestinal parasitic diseases include:
- A07.1 Giardiasis (lambliasis)
- A07.2 Cryptosporidiosis
- A07.4 Cyclosporiasis
Category A08 provides classification of viral enteritis and gastroenteropathies, viral and other specified intestinal infections. For example:
- A08.0 Rotaviral enteritis
- A08.11 Acute gastroenteropathy due to Norwalk agent
- A08.2 Adenoviral enteritis
ICD-10 also classifies foodborne intoxications which are caused by toxins in food or heavy metals, chemicals or other substances that have become concentrated in food. Category A05, Other bacterial foodborne intoxications, not elsewhere classified, contains codes for the more common infectious organisms that produce toxins responsible for the disease processes. Examples of foodborne intoxications include:
- A05.0 Foodborne staphylococcal intoxication
- A05.1 Botulism food poisoning
- A05.2 Foodborne Clostridium perfringens (Clostridium welchii) intoxication
There are two reasons why foodborne illnesses are more common in the summer. First, the bacteria present in soil, air, water and in the bodies of people and animals grow faster in the warm summer months. Second, in the summer, people tend to cook outdoors where thermostat-controlled cooking, refrigeration and washing facilities are usually not available. This leads to food contamination.
Physicians need to assign the right medical diagnosis and procedure codes when reporting foodborne illnesses. This is easier with help from experts. Coders in medical coding companies have a good understanding of the reasons for the introduction of new and revised classifications of some diseases and disease processes in ICD-10, which allows them to locate and assign the correct codes.