# icd 10 for "mixed flora"



## alamphere (Feb 27, 2018)

With regard to UTIs (N39.0), I'm looking to code the cause of the infection for cultures that come back as only "mixed flora."  The index leads me to A49.8 Other bacterial infections of unspecified site.  Per the tabular index, A49 excludes "bacterial agents as the cause of diseases classified elsewhere (B95-B96)."  When I get to B95-B96, the only appropriate codes seems to be B96.89.  Thoughts?


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## thomas7331 (Feb 27, 2018)

Since a urine culture is a clinical lab, not a pathology interpretation, the result should not be used for coding since it is not a physician diagnostic statement.  'Mixed flora' in the urine as a result also does not necessarily imply an infection or cause unless the provider has specifically stated so.  I would code only from what the physician has dictated in their assessment as a cause of the UTI, if any.


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## alamphere (Feb 28, 2018)

Thomas, thank you for your reply.  In our facility, the ED doctors include a statement regarding the final clinical lab result of a urine culture in their final report, so I have been told to include the specific cause of the infection in my coding.  If the physician does state that "mixed flora" is the final result of a urine culture and states "no change to plan" as the patient is already on an antibiotic, do I infer that "mixed flora" is the cause?   If I am already coding UTI (N39.0), is it necessary to include the specific code that is the reason for infection?


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## thomas7331 (Feb 28, 2018)

I wouldn't make that inference if the provider is just restating the lab result, but even if you did, my thought is that there is no appropriate code.  B96.89 is for 'other specified' bacteria, and 'mixed flora' is not specific.  There is no information in this statement to indicate what type of bacteria is present or whether or not it is responsible for the infection, and I don't think there's a code for unspecified type of bacteria that would fit.  

I recall this was a question that came up a lot during rollout of ICD-10 a couple years back - the ICD-10 instructions for UTI state to use an additional code to identify the infection agent but physicians often simply don't have this information when they make this diagnosis, and medical guidelines do not allow physician to test a patient for something simply because they need to come up with a code.  There wasn't any coding guidance, that I know of, on what should be done in at case.  The facility where I worked at the time made the determination to not code for a cause if it wasn't known and to my knowledge, this never cause a problem with denials or audit findings.  Perhaps someone on the forum with more ICD-10 background can give some additional input about this situation.


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