Chapter 1 - Certain Infectious and Parasitic Diseases (Part 3)

on Tuesday, 12 November 2013. All News Items | Documentation | Coding

Methicillin-resistent Staphylococcus Aureus (MRSA) Infection

MRSA is a very tough to treat infection caused by a strain of staph bacteria that has become resistant to commonly used antibiotics generally used to treat ordinary staph infections.

  • Can be life threatening.
  • MRSA infection can be contagious by:
    1. Person-to-person / skin-to-skin contact.
    2. Coming in contact with materials or surfaces touched by a MRSA infected person or carrier
  • A “carrier” is a person that that harbors the organism (MRSA) without manifesting symptoms of the infection.
  • A carrier (Z22.322) can transmit the MRSA infection.
  • Requires “isolation” while being treated.
  • Typically causes skin sores and infections such as:
    1. Abscess
    2. Boils
    3. Stys
    4. Ulcers
    5. Cellulitis
    6. Impetigo
    7. Carbuncles
  • MRSA can quickly spread once the germ has entered into the body.
    1. Bones
    2. Joints
    3. Bloodstream (Sepsis - )
    4. Muscle, Fascia (Necrotizing Fasciitis)
    5. Organs
      • Brain (Meningitis)
      • Heart (Endocarditis)
      • Lungs (Pneumonia)
      • Kidneys (UTI associated with Foley Catheter)

Health Care-Associated MRSA (HA-MRSA)

  • Affects people who have been treated in a health-care facility such as:
    1. Hospitals
    2. Nursing Homes
    3. Rehab facilities
    4. Dialysis center
    5. Physician’s office
  • Commonly seen in patients with:
    1. Weakened immune system from:
      1. Illness
      2. Long term medication therapy
      3. Cancer treatment
    2. Surgical history within a year
    3. Lengthy admissions to hospitals and/or long-term care facilities
    4. Chronic Kidney Disease on hemodialysis
    5. History of IV drug use

Community-Associated MRSA (CA_MRSA)

  • MRSA showing up in healthy people outside of a health care setting
  • Healthy people who may also be at risk:
    1. Military
    2. Children at day-care
    3. Athletes
    4. Prison inmates
    5. People who share items such as towels and razors
    6. People who have gotten tattoos and/or piercings

Signs and Symptoms

  • Non-healing wound
  • Headache
  • Fatigue
  • Rash
  • Fever and chills
  • Low blood pressure
  • Shortness of breath
  • Chest pain
  • Weakness

Treatment

MRSA is resistant to some antibiotics but is still a treatable condition. There are some kinds of antibiotics that still work.

  • Treatment often starts with Bactrim and Vancomycin.
  • Other antibiotics used are:
    1. Clindamycin
    2. Minocycline
    3. Tygacil
    4. Cubicin
    5. Zyvox
    6. Synercid
  • Unfortunately, even with these medications, there is emerging antibiotic resistance developing.
  • Antibiotics are not always necessary.
    • With early detection, in cases of a skin abscess or boil caused by MRSA, an incision and drainage may be all that is necessary.

Selection and Sequencing of MRSA Codes

Coding Guidelines:

  • Section I.C.1.e.1.a. – Combination Codes for MRSA Infection:   When a patient is diagnosed with an infection that is due to Methicillin Resistant Staphylococcus Aureus (MRSA), and that infection has a combination code that includes the causal organism (e.g., Sepsis, Pneumonia) assign the appropriate combination code for the condition (e.g., code A41.02, Sepsis due to Methicillin Resistant Staphylococcus Aureus or code J15.212, Pneumonia due to Methicillin Resistant Staphylococcus Aureus). Do not assign code B95.62, Methicillin Resistant Staphylococcus Aureus Infection as the cause of diseases classified elsewhere, as an additional code because the combination code includes the type of infection and the MRSA organism. Do not assign a code from subcategory Z16.11, Resistance to Penicillins, as an additional diagnosis.
  • Section I.C.1.e.1.b. – Other Codes for MRSA Infection:   When there is documentation of a current infection (e.g., wound infection, stitch abscess, urinary tract infection) due to MRSA, and that infection does not have a combination code that includes the causal organism, assign the appropriate code to identify the condition along with code B95.62, Methicillin Resistant Staphylococcus Aureus Infection as the cause of diseases classified elsewhere for the MRSA infection. Do not assign a code from subcategory Z16.11, Resistance to Penicillins.
  • Section I.C.e.1.c. – Methicillin Susceptible Staphylococcus Aureus (MSSA) and MRSA Colonization:   The condition or state of being colonized or carrying MSSA or MRSA is called colonization or carriage, while an individual person is described as being colonized or being a carrier. Colonization means that MSSA or MRSA is present on or in the body without necessarily causing illness. A positive “MRSA screen positive” or “MRSA nasal swab positive”.
  • Assign code Z22.322, Carrier or suspected carrier of Methicillin Resistant Staphylococcus Aureus, for patients documented as having MRSA colonization. Assign code Z22.321, Carrier or suspected carrier of Methicillin Susceptible Staphylococcus Aureus, for patient documented as having MSSA colonization. Colonization is not necessarily indicative of a disease process or as the cause of a specific condition the patient may have unless documented as such by the provider.
  • Section I.C.1.e.1.d. – MRSA Colonization and Infection:   If a patient is documented as having both MRSA colonization and infection during a hospital admission, code Z22.322, Carrier or suspected carrier of Methicillin Resistant Staphylococcus Aureus, and a code for the MRSA infection may both be assigned.

Methicillin-susceptible Staphylococcus Aureus (MSSA) Infection

Another commonly known infection caused by the staph bacteria is Methicillin-susceptible Staphylococcus Aureus (MSSA). MSSA is able to be treated with most penicillin based antibiotics and has yet become resistant to the more common antibiotics enabling the treatment to be cleared up easier than it would be if it was resistant in the case of MRSA.

MSSA can be as serious as MRSA. Signs and symptoms are the same.

The implementation date of ICD-10-CM/PCS is fast approaching. ICD-10-CM/PCS will require coders to possess an in-depth knowledge and understanding of anatomy & physiology and pathophysiology.   Coders’, who are well-versed on how a body in both the healthy state as well as during the disease process should function, will be better prepared to query providers for clarification when additional documentation is required.  In turn, a coder will be able to make appropriate correlations when reviewing documentation and be able to avoid needless queries.

Article by Marsha Manning

Marsha Manning RHIT, CCS, AHIMA Approved ICD-10-CM/PCS Trainer, is an Inpatient Coding Consultant at Medical Management Plus, Inc.  Marsha has over 24 years experience in the coding profession and has held various positions such as DRG coordinator, Coding Supervisor and HIM Supervisor. In her current position, Marsha reviews records and assists clients with coding accuracy, compliance, education and Case Mix Index (CMI) as they relate to specific entities concerning Medicare. You may contact Marsha at This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it..

 

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