ICD Code A04.7

ICD code A04.7 is enterocolitis caused by Clostridium difficile, a bacterial infection that leads to inflammation of the colon and small intestine, often resulting in diarrhea and abdominal pain.

1. Patient presents with diarrhea, which may be watery or bloody

2. Abdominal pain and cramping are reported

3. Fever is present

4. Laboratory confirmation of Clostridium difficile toxin or organism in stool

5. Recent history of antibiotic use or hospitalization

6. Absence of other causes for enterocolitis (e.g., negative tests for other pathogens)

7. Signs of colitis on imaging or endoscopy, such as pseudomembranes or colonic inflammation

Relevant CPT codes that may be used to treat ICD code A04.7 include:

- 87493 (Infectious agent detection by nucleic acid [DNA or RNA]; Clostridium difficile, amplified probe technique)

- 87511 (Infectious agent detection by nucleic acid [DNA or RNA]; Clostridium difficile, direct probe technique)

- 87045 (Culture, bacterial; stool, aerobic)

- 87103 (Culture, typing; aerobic bacteria, each isolate)

- 99201–99499 (Evaluation and management services, depending on setting and complexity)

- 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour)

- 36415 (Collection of venous blood by venipuncture)

- 96372 (Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular)

- 44388 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed)

- 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression)

CPT code selection should be based on the specific services rendered and clinical documentation.

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