Lecture on MRSA Coding Guidelines

Introduction

• MRSA: Methicillin-Resistant Staphylococcus Aureus
  • A type of bacteria difficult to treat
  • Resistant to penicillin and related antibiotics

Coding Guidelines

Guideline C1.e.1.a

• Combination Code Usage:
  • Use combination code for infection and causal agent when available
  • Example: A49.02 (i.e., Staphylococcus infection, methicillin-resistant)
  • b95.62 should not be used when combination code is available
  • Do not code resistance to penicillin separately; it is understood in the term MRSA

Guideline C1.e.1.c

• MRSA Carrier without Infection:
  • Use code Z22.322 for patients who are carriers without current infection
  • Do not code as having the condition

Example Scenario – Coding Practice

Patient Case

• 55-year-old female with red, swollen, non-healing abscess on her leg
• Antibiotic treatment for 7 days, no improvement
• Culture test positive for MRSA

Keywords/Inventory

• Red, swollen, non-healing abscess on leg
• Warm to touch
• Physician suspects MRSA confirmed by culture

Diagnosis

• Two diagnoses:
  • Non-healing abscess on leg
  • MRSA infection

Eliminating Wrong Codes Based on Guidelines

• Z16.11 (Penicillin resistance) – Do not use because it’s redundant
• b95.62 should follow the condition code (not preceding)
• Combination code A49.02 is appropriate when available
• Code sequence: Condition code first, MRSA code second
  • Answer: A = L02.419 + b95.62

Case Study 2

Patient Case

• 70-year-old male with injured toe leading to red, swollen, warm area with purulent drainage
• Develops severe symptoms including shortness of breath, high temperature, decreased urinary output
• Diagnosed with acute renal failure due to severe sepsis from MRSA pneumonia

Keywords/Inventory

• Injured toe, red swollen warm
• Purulent drainage, positive for MRSA
• Acute renal failure due to severe sepsis
• MRSA pneumonia

Diagnosis

• Sepsis is primary due to systemic infection
• Guidelines for coding severe sepsis with organ dysfunction

Sequencing Order

1. Systemic organism infection (sepsis due to MRSA)
2. Severe sepsis (without shock)
3. Organ dysfunction (renal failure)

Appropriate Codes Based on Case

• A41.02 - Sepsis due to MRSA (combination code for systemic infection)
• J15.212 - Pneumonia due to Staphylococcus
• R65.20 - Severe sepsis without septic shock
• N17.9 - Acute kidney failure
  • Answer: B = A41.02 + J15.212 + R65.20 + N17.9

Additional Coding Guidelines

MSSA (Methicillin-Susceptible Staphylococcus Aureus)

• Guideline C1.e.1.a - Code as b95.61 if infection is susceptible
  • Carrier code: Z22.321