2025 ICD-10-CM code A31
(Active) Effective Date: N/A Certain infectious and parasitic diseases - Other bacterial diseases (A30-A49) 1 Feed
Infection due to mycobacteria other than Mycobacterium tuberculosis and Mycobacterium leprae.
Medical necessity for services related to A31 is established by documenting the signs, symptoms, and diagnostic results confirming the presence of an active NTM infection requiring treatment. The documentation should also explain the rationale for the chosen treatment approach.
The provider plays a critical role in diagnosing and managing NTM infections.Diagnosis often involves laboratory analysis of samples (biopsy, sputum, blood, etc.) to identify the specific mycobacteria.Treatment typically includes long-term multidrug antibiotic therapy, sometimes for up to 12-36 months, and surgery may be necessary in severe cases.The provider also performs a thorough clinical evaluation to assess the extent of the infection and any underlying conditions contributing to the patient's susceptibility.
In simple words: This code represents an infection caused by a type of bacteria called mycobacteria, other than the ones that cause tuberculosis or leprosy. These bacteria are found in the environment and can cause different types of infections, especially in people with weaker immune systems.
This code encompasses infections caused by various nontuberculous mycobacteria (NTM), excluding tuberculosis (A15-A19) and leprosy (A30.-). These organisms are widespread in the environment and typically cause infections in individuals with weakened immune systems, although they can also affect healthy individuals. Manifestations vary depending on the specific mycobacteria involved, the site of infection (pulmonary, cutaneous, disseminated, etc.), and the patient's overall health. Examples of NTM include Mycobacterium avium complex (MAC), Mycobacterium kansasii, Mycobacterium marinum, Mycobacterium abscessus, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium ulcerans.
Example 1: A child presents with chronic swollen lymph nodes in the neck. Biopsy and culture reveal Mycobacterium avium complex (MAC) infection., An individual with a history of lung disease develops a cough, weight loss, and fatigue. Sputum culture confirms pulmonary infection with Mycobacterium kansasii., A patient develops a persistent skin lesion after cleaning a home aquarium.The lesion is diagnosed as a Mycobacterium marinum infection (swimming pool granuloma).
Documentation should include details of the patient's symptoms, medical history, diagnostic tests (e.g., culture, biopsy, imaging studies), and treatment plan. The specific mycobacterial species identified should be documented, along with any antimicrobial susceptibility testing results. Documentation should also justify the medical necessity of the services provided.
- Specialties:Infectious disease, pulmonology, dermatology, general surgery are common specialties dealing with mycobacterial infections.
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office, Independent Clinic, Federally Qualified Health Center and others depending on the severity and manifestation of infection.