ICD Code B96.1

ICD code B96.1 is used to identify Klebsiella pneumoniae [K. pneumoniae] as the causative agent of diseases that are classified under different primary conditions. This code is typically used as an additional code to specify the bacterial cause of an infection when Klebsiella pneumoniae is responsible, but the primary disease is listed elsewhere in the ICD classification. It helps in accurately documenting and coding the bacterial etiology of infections for better clinical management and billing purposes.

1. Confirmed Presence of Klebsiella pneumoniae: The patient must have a confirmed laboratory diagnosis indicating the presence of Klebsiella pneumoniae. This confirmation typically comes from cultures or other diagnostic tests that identify the bacterium.

2. Associated Disease or Condition: The Klebsiella pneumoniae must be identified as the causative agent of a specific disease or condition. This means that the bacterium is directly responsible for the clinical manifestations observed in the patient.

3. Symptoms Consistent with Infection: The patient should exhibit symptoms that are consistent with an infection caused by Klebsiella pneumoniae. Common symptoms may include fever, chills, cough, shortness of breath, or other signs of infection depending on the affected organ system.

4. Exclusion of Other Pathogens: Other potential pathogens should be ruled out as the primary cause of the disease. This involves ensuring that Klebsiella pneumoniae is the primary or significant contributing factor to the patient's condition.

5. Documentation in Medical Records: The diagnosis and the role of Klebsiella pneumoniae as the causative agent must be clearly documented in the patient's medical records. This documentation should include the results of diagnostic tests and the clinical rationale for the diagnosis.

6. Classification of Disease Elsewhere: The disease or condition caused by Klebsiella pneumoniae should be classified under a different ICD code that specifies the primary disease entity. The use of this code indicates that Klebsiella pneumoniae is the underlying cause of a condition classified elsewhere in the ICD system.

For the ICD code B96.1, which pertains to Klebsiella pneumoniae as the cause of diseases classified elsewhere, the relevant CPT codes would depend on the specific medical services or procedures performed to treat the condition associated with this bacterial infection. Here are some general categories of CPT codes that might be applicable:

1. Evaluation and Management (E/M) Codes: These codes (99201-99499) are used for office visits, hospital visits, and consultations where the healthcare provider evaluates and manages the patient's condition.

2. Laboratory and Pathology Codes: If laboratory tests are conducted to diagnose or monitor the infection, relevant CPT codes might include:

   - 87040: Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates

   - 87070: Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates

3. Radiology Codes: If imaging studies are required to assess the extent of the infection, such as a chest X-ray for pneumonia, relevant CPT codes might include:

   - 71045: Radiologic examination, chest; single view

   - 71046: Radiologic examination, chest; two views

4. Procedure Codes: If surgical or other invasive procedures are necessary to treat complications or severe cases, relevant CPT codes might include:

   - 32551: Tube thoracostomy, includes water seal (e.g., for pleural effusion or empyema)

5. Antibiotic Administration Codes: If antibiotics are administered intravenously, relevant CPT codes might include:

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

It's important to note that the selection of CPT codes should be based on the specific services provided and documented in the patient's medical record. Healthcare providers should ensure accurate coding to facilitate proper billing and reimbursement.

Discover how MD Clarity's RevFind software can optimize your revenue cycle by accurately reading your contracts and detecting underpayments for CPT codes associated with ICD code B96.1. Schedule a demo today to see how RevFind ensures you receive the full reimbursement you deserve.