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Coding for Methicillin-Resistant Staphylococcus Aureus (MRSA)

By Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC
October 26, 2011

Although October 2, World MRSA Day, has come and gone, the month of October is still dedicated as MRSA awareness month. In 2009, U.S. Senate resolution 301 made it possible to make MRSA much more visible and to educate others on the increasing incidence of MRSA infections by establishing a month dedicated to promoting awareness of MRSA.

MRSA is a bacterium responsible for several hard-to-treat infections and is caused by a strain of Staphylococcus aureus that is resistant to many antibiotics. S. aureus is found on the skin and in the nasal cavities of 25-30% of the US population. In most healthy individuals this causes no major problems. However, if the organisms get into the body through a cut or an open area(s), S. aureus can become a serious infection. If the S aureus strain is resistant to most antibiotics commonly used to treat staph infections, it is referred to as MRSA. MRSA is found on the skin of approximately 1-2% of healthy individuals. MRSA infections are much more serious and difficult to treat. Like other strains of staphylococcus, MRSA bacteria usually enter the body through a broken area in the skin although other entry sites include: the respiratory tract, surgical or other open wounds, intravenous catheters, and the urinary tract. While most MRSA infections involve only the skin and present as a boil or small bump-like blemishes, serious and often life-threatening infections also occur including: cellulitis, sepsis, and pneumonia. Patients with a compromised immune system are at a significantly greater risk of symptomatic secondary infection.

Other names for MRSA include multidrug-resistant Staphylococcus aureus or oxacillin-resistant Staphylococcus aureus (ORSA). MRSA is any strain of Staphylococcus aureus bacteria that has developed a resistance to beta-lactam antibiotics, which include penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and cephalosporins. It has been termed a ‘Superbug’, that often presents as a deadly flesh-eating bacteria that has taken thousands of lives globally each year.

First seen in the UK in 1961, this bacterium began as a hospital acquired infection, but is now seen in the community and gathering places, such as schools. Depending on the source of the infection MRSA is referred to as either community-acquired (CA-MRSA) or hospital-acquired (HA-MRSA). Although there may be other means of transmission, the focus in this article will be on CA-MRSA and HA-MRSA.

Community-Acquired MRSA
Community-acquired MRSA infections develop from exposure to a carrier or contaminated surface in the community and may be on the rise for a number of reasons:

  • Release of patients from the hospital into the community with asymptomatic or sub-symptomatic MRSA infections
  • Rise of outpatient procedures
  • MRSA silent-carriers. These individuals are unaware that they harbor the infection and the infection is transmitted from person to person via direct contact and by contaminated objects

Hospital-Acquired MRSA Infections
Hospital-acquired MRSA is an infection picked up by a patient who is admitted to the hospital for an unrelated problem and subsequently becomes infected by MRSA from a hospital source. To date, most of the concern has been related to hospital acquired MRSA (HA-MRSA) also called a nosocomial infection. Hospitals have been the source of most MRSA infections for the following reasons:

  • Patient population with weaker immune systems
  • Hospital staff possibly carrying these superbugs as they move from patient to patient
  • Routine use of broad-spectrum antibiotics provides selective pressure that causes the microorganisms to become resistant
  • Many hospital procedures are invasive, meaning they break the skin and introduce the organisms directly into the body

Even though it is called ‘hospital-acquired’ MRSA, patients may obtain the infection from any health care facility, such as long term care facilities and nursing homes. An infection is considered hospital-acquired if it develops within 30 days of hospital release.

Coding for MRSA
One significant difference in coding for MRSA in ICD-9-CM and ICD-10-CM is that in ICD-9-CM there are specific codes for MRSA infections, while in ICD-10-CM a code for S. aureus is reported along with Z16 to indicate an infection with a drug resistant organism. Coding for MRSA in both ICD-9-CM and ICD-10-CM usually requires the use of more than one code.

MRSA Sepsis

ICD-9-CM:

038.12 Methicillin-resistant Staphylococus aureus septicemia
995.91 Sepsis

or

038.12 Methicillin-resistant Staphylococus aureus septicemia
995.92 Severe sepsis
with
785.52 Septic shock
And/or
A code for any acute organ dysfunction

For a newborn with MRSA sepsis:
771.81 Septicemia (sepsis) of newborn
041.12 Methicillin-resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site
Note: Do not use 995.91 with 771.81 as 771.81 describes the sepsis. However, if severe sepsis is present code as follows:
771.81 Septicemia of newborn
041.12 Methicillin-resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site
995.92 Severe sepsis
with
785.52 Septic shock
And/or
A code for any acute organ dysfunction

For MRSA sepsis associated with a surgical procedure or with pregnancy, childbirth or the puerperium, refer to your ICD-9-CM code book for coding instructions.

ICD-10-CM:

A41.0 Sepsis due to Staphylococcus aureus
Z16 Infection with drug resistant microorganisms

If the patient has severe sepsis also code
R65.21 Severe sepsis without septic shock
Or
R65.22 Severe sepsis with septic shock

Any acute organ dysfunction is also reported

For a newborn with MRSA sepsis
P36.2 Sepsis of newborn due to staphylococcus aureusZ16 Infection with drug resistant microorganisms

If the newborn has severe sepsis also code

R65.21 Severe sepsis without septic shock
Or
R65.22 Severe sepsis with septic shock

Any acute organ dysfunction is also reported

For MRSA sepsis associated with a surgical procedure or with pregnancy, childbirth or the puerperium, refer to your ICD-10-CM code book for coding instructions.

MRSA Pneumonia

ICD-9-CM:

482.42 Methicillin-resistant pneumonia due to Staphylococcus aureus

ICD-10-CM:

J15.21 Pneumonia due to staphylococcus aureus
Z16 Infection with drug-resistant microorganisms

MRSA Infections Associated With Surgical Procedures

ICD-9-CM:

998.59 Other postoperative infection

or

674.3x Other complications of obstetrical surgical wounds

and

041.12 Methicillin-resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site

In ICD-10-CM:

T81.4xx- Infection following a procedure
Or
O86.0 Infection of obstetric surgical wound
And
B95.6 Staphylococcus aureus as the cause of diseases classified elsewhere
Z16 Infection with drug-resistant microorganisms

MRSA Carrier

ICD-9-CM:

V02.54 Carrier or suspected carrier of Methicillin-resistant Staphylococcus aureus.

ICD-10-CM:

Z22.32 Carrier of bacterial disease due to staphylococci

 

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