Pediatric Coding Alert
Follow ICD-10 Guidelines to Mend This MRSA Mistake
Question: Our pediatrician saw a patient that was seen for left leg abscess. The pediatrician had the wound cultured, and the infection came back as methicillin-resistant Staphylococcus aureus (MRSA). My nurse practitioner (NP) coded the claim with A49.02, which was denied by Medicaid as the code is for an unspecified site. I think I have to code it with L02.416 then B95.62. My NP disagrees with me. Which one of us is correct? Colorado Subscriber Answer: Coding this encounter with A49.02 (Methicillin resistant Staphylococcus aureus infection, unspecified site) would not be correct. Here’s why. According to ICD-10 guideline I.C.1.e, “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.” Altogether there are two MRSA combination codes: As neither of these codes describe an abscess due to MRSA, they do not apply to the scenario you describe. Instead, you would follow the guideline and use L02.416 (Cutaneous abscess of left lower limb) and B95.62 (Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere).
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