Q&A: The value of identifying causative organisms

Q: I’ve been told that in most cases codes for viral causative organisms, B95-97, will not add a CC or an MCC. However, I thought that identifying a causative organism often does add a CC/MCC. Could you clarify this for me? 

A: Anytime you have a patient with an infection, regardless of the type of infection (systemic or localized), we want to ask the provider to identify the causative organism and link the organism to the infection if possible. Just documenting that the patient has pneumonia and methicillin-resistant staphylococcus (MRSA) is not enough, their documentation needs to demonstrate a “cause and effect” meaning that the MRSA is the organism responsible for the pneumonia.

Codes B95-97 are used for infections that are not coded using an infectious disease code (A00-B95):

• B95, Streptococcus, staphylococcus, and enterococcus as the cause of diseases classified elsewhere
• B96, Other bacterial agents as the cause of diseases classified elsewhere
• B97, Viral agents as the cause of diseases classified elsewhere

Let’s use acute sinusitis as an example, which is a respiratory condition, and falls to J01, Acute sinusitis. Under the code, you will find the note that reads “use additional code (B95-B97) to identify infectious agent.”

In this case, neither the J01 code or the code used to identify the type of infection will result in an MCC or CC.

Now, streptococcal meningitis code G00.2, includes a note that reads “use additional code to further identify organism (B95.0-B95.5).” In this case, however, the B95.0-B95.5 code that identifies the organism will result in an MCC.

Here are some other examples to look at:

• A49.1, Streptococcal infection, unspecified site, will not result in a CC/MCC (and there are no instructions to use an additional code to identify the organism).
• J13, Pneumonia due to streptococcus pneumonia, is an MCC. It’s a type of code that identifies both the infection and the causative organism in one code rather than two codes.

I also suggest reaching out to your infectious control team and see if they would be willing to help with staff education. Remember that cultures are not necessary to identify an organism. A physician can use the terminology such as “probable,” “suspected,” or “likely” as long as it’s stated at the time of discharge as remaining “probable,” “suspected” or “likely” and they can also use the terminology “as evidenced by” taking into consideration the patient’s presentation, signs, and symptoms or response to treatment.

Editor’s Note: Sharme Brodie, RN, CCDS, CCDS-O, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps, click here. This article originally ran in June 2019 and has been updated according to all new coding and documentation guidelines.