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Chapter 5:
Infectious and Parasitic Diseases
MED 122
THIS CHAPTER IS ABOUT
Diseases that are recognized as
communicable or transmissible and some
diseases of unknown but possibly infectious
origin.
 The infectious and parasitic diseases are
classified by body site and organism.
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HOW IS THIS DIAGNOSED?
There are laboratory tests that are used in the
Diagnosis and Treatment of Infectious Diseases.
This tells you the type of bacteria involved.
 Smear and stain examinations
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Gram stain
Gram positive and Gram negative organisms
Acid-fast stains are used when bacteria does not stain
well with the Gram Stain.
Other staining methods listed on page 71.
AFTER THE LAB TEST A DR MAY ORDER…
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Cultures
The rate of growth, atmospheric needs (anaerobic vs
aerobic) and nutritional requirements of the bacterium are
clues to it’s identity.
Broths, and agar are most commonly used as growth
media.
Grouping of the bacteria growth is called a colony.
Other id’s are odor, pigment, shape, size and consistency
of the colony.
Sensitivity tests will tell what antibiotic will treat the
infection.
SEROLOGIC STUDIES
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Serologic Studies
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These blood tests are used to provide a specific
diagnosis when attempts to identify an infectious
agent are unsuccessful or impractical or when
culture techniques are unavailable
Infectious diseases diagnosed by serologic
studies are:
Syphilis, rubella, mycoplasma pnueumoniae, Lyme
disease and mononucleosis.
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When a good sputum specimen is collected the
gram stain is rapid, simple, and a inexpensive
technique to diagnose bacterial pneumonia.
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What’s the ICD code for bacterial pneumonia?
MICROORGANISMS THAT CAUSE INFECTIONS
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Bacteria- can be gram positive (+) or gram negative (-)
Parasites- these organisms that live in or on another living
organism
Fungi- Cause infectious diseases including poisonings,
allergies, cutaneous, or mucous membrane infections
o Fungi Does not spread from person to person
Virus- infectious microorganism that is much smaller than a
bacterium and survives only within a living host cell because it
doesn’t have it’s own RNA/DNA
The entire health record must be reviewed to identify the body
site, severity, specific organism or parasite, etiology of the
infection, and associated signs & symptoms
ALSO DEPENDS ON SHAPE. THEY MAY BE
IN CLUSTERS OR CHAINS
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Gram (+) the organism stain
purple
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Streptococcus
Staphylococcus
Clostridium
Anthrax
Listeria
Lactobacillus
Peptococcus
COMMON BACTERIA
RODS –
COCCI 
Gram (–) the organism stain
red
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Salomonella
Proteus
Shigella
Neisseria
Enterobacteriaceae
Serratia
SHAPE
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Cocci in chains
Cocci in clusters
Straight rods
Brick shaped rods
ORGANISM
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Streptococci
Staphylococci
Salmonella
Clostridium perfringens
GRAM STAINING WILL TELL THE SHAPE OF THE
BACTERIUM. RODS VS COCCI
PARASITES
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Worms are parasites and
include tapeworms, flukes,
roundworms, pinworms,
hookworms, and whipworms.
FUNGI
Candidiasis infection is most
common fungi.
o Disease may be localized to
the mouth, throat, skin,
scalp, vagina, fingers, nails,
bronchi, lungs, or GI tract.
COMMON PARASITES AND FUNGI
COMMON VIRAL INFECTIONS
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Adenoviridae
Arbovirus
Aseptic meningitis
Cytomegalovirus
Epstein-Barr virus
Hepatitis viruses
Herpes simplex virus
HIV
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Influenza virus
Measles
Mumps
Papilloma viruses
Paralytic poliomyelitis
Respiratory syncytial
virus
Varicella zoster
Rabies
CODING THE BUGS, SEQUENCING RULES
Multiple coding is often necessary to
completely describe an infectious condition and
the organism that caused it.
 Infectious agents are assigned as secondary to
describe the causing organism when the
organism is not specified in the code title.
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Example: UTI due to E. coli
599.0, UTI
041.4, E. coli
V09
Code V09 is used as an additional code for
infectious conditions to indicate the presence
of drug resistance in the infectious organism.
 Code assignment should not be based on the
laboratory or sensitivity report alone.
 The physician should document this in the
record.
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SOME BACTERIA
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Streptococcus (group A) responsible for URI’s spread
by droplets or direct contact.
Streptococcus pneumoniae found in the mouth of
10%-40% of people. This bug can also cause lobar
pneumonia in adults and sinusitis & otitis media in
children and meningitis in elderly people.
S. aureus cause infections involving the skin and
subcutaneous tissues, the eye, or ear. Can also cause
pneumonia, endocarditis, food poisoning, toxic shock
syndrome. Can be transmitted by direct spread or
through the bloodstream.
TUBERCULOSIS (TB)
TB is highly contagious, an acute or chronic
infection caused by Mycobacterium
tuberculosis.
 It occurs primarily in the lungs, but it can occur
in other sites.
 A fifth digit is required to identify the method
used to establish the diagnosis.
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STREPTOCOCCAL (STREP) SORE THROAT
ICD-9-CM classifies strep throat to code 034.0.
 No additional code is necessary to identify the
organism because it is already included in the
title of code 034.0.
 Find 034.0 in your ICD-9 book now.
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SEPTICEMIA
Septicemia is a bloodstream infection caused
by the entry of pathogens into the blood.
 Blood cultures are usually positive but can be
negative in a patient with the disease.
 Septicemia codes include the underlying
disease.
 Coding guidelines exist for septicemia, septic
shock, and SIRS. (what’s SIRS?)
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SEPSIS, SEE PAGE 77
The terms septic shock, severe sepsis, sepsis
and septicemia may be used interchangeably
by physicians but they are clinically distinct
conditions.
 The term sepsis is indexed to code 995.91 and
severe sepsis is indexed to code 995.92
 Septic shock meets the definition of severe
sepsis
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CODING SEPSIS
The “code first” note at subcategory 995.9
provides instruction that the underlying cause
of the sepsis should be coded first.
 In the absence of a specified underlying
condition, the default first code should be
038.9.
 If documentation is unclear whether the sepsis
was present on admission, ask the provider.
 The term sepsis or SIRS must be documented
to assign a code from subcategory 995.9.
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MENINGITIS
Bacterial meningitis is an inflammation of the
meninges and is classified to category 320.
 However, Meningococcal meningitis is coded
with 036.0.
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CHILDHOOD COMMUNICABLE DISEASES
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Chicken pox (052) or varicella
is a common acute and highly
contagious infection caused by
the herpes virus varicella
zoster. Category is subdivided
to identify the presence or
absence of complications.
Measles (055) is one of the
most common illnesses
known. Category is subdivided
to identify the presence or
absence of complications.
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Rubella (056), or German
measles, is an acute, mildly
contagious viral disease.
Category 056 is further
subdivided to identify
complications.
When rubella is documented
as congenital, code 771.0
should be assigned.
HERPES- CONTAGIOUS STUFF!
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Herpes zoster (053), or shingles, is a severe infection
caused by the varicella zoster virus.
Herpes simplex type 1 & 2 is the gift that keeps on
giving!
Herpes simplex 1 is transmitted by oral & respiratory
secretions, affecting skin & mucous membranes with
cold sores and fever blisters.
Herpes simplex 2 affects primarily the genital area
and is transmitted by sexual contact.
HEPATITIS
Viral hepatitis (070) is an inflammation of the liver
caused by a virus.
 The five forms of hepatitis include:
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Type A- contagious, transmitted by oral-fecal route
Type B- transmitted by direct exchange contaminated
blood, human secretions, feces.
Type C- transmitted through blood transfusions. The
blood donors do not know they have it.
Type D- found only in patients with acute/chronic
episode of hepatitis B
Type E- transmitted enterally (what’s this?)
CANDIDIASIS
Candidiasis (112) is a fungal infection caused by
the Candida species moniliasis.
 The category is further subdivided to identify the
specific site affected. This is usually a mild &
superficial. Occurs in nail, skin, mucous
membranes, vagina, esophagus, and GI tract.
Sometimes can enter the bloodstream and invade
kidneys, lungs, brain or other major organs.
 Neonatal candida monilia infection is excluded
from this category and is assigned to 771.7.
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STD’S
Contagious, spread by sexual contact or
intercourse.
 Include:
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Syphilis (090–097)
Gonorrhea (098)
Chlamydia (099.5) with fifth digits identifying
specific sites
INFECTIOUS GASTROENTERITIS
Caused by a variety of organisms including
bacteria, viruses, and parasites.
 Some of the symptoms include: severe nausea,
vomiting, anorexia, abdominal cramps, fever,
malaise, muscle aches, hypokalemia, acidosis.
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Several categories are used to classify including
003.0, Salmonella gastroenteritis; 005, Other food
poisoning; and 008, Intestinal infections due to other
organisms.
NONINFECTIOUS GASTROENTERITIS
Gastroenteritis not specified as infectious is
assigned to either 558.1, 558.2, 558.3, or
558.9.
 Under code 558.3 (Allergic gastroenteritis and
colitis), there is a note to “use additional code”
to identify the type of food allergy (V15.01–
V15.05).
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HIV
Presence of HIV in blood indicates HIV infection.
 HIV1 infection involves five phases, see pg 80
 Health records with diagnostic statements of
“suspected,” “likely,” “possible,” or “questionable”
HIV should be returned to the physician for
clarification.
 Patients who are seen for an HIV-related illness
will be coded with at least two codes—one for the
HIV disease and one for the manifestation.
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EXAMPLE
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Delivery of a male infant in mother with AIDS
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647.61, Other specified infectious and parasitic disease
in the mother
042, HIV disease
V27.0, Outcome of delivery
If a patient with symptomatic HIV disease or AIDS
is admitted for an unrelated disease, such as
traumatic injury, the code for the unrelated
condition is listed first, followed by the code for the
HIV infection.
EXAMPLE
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Patient was seen by the physician who
diagnosed acute appendicitis; patient also has
AIDS.
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540.9, Acute appendicitis
042, HIV disease
CODING HIV
V08, Asymptomatic human immunodeficiency
virus infection, indicates that the patient has a
virus in the blood but has no symptoms of an
HIV-related disease.
 042, HIV disease, indicates that the patient has
an HIV-related disease.
 795.71, Nonspecific serologic evidence of HIV
is used for patients with inconclusive HIV test
results
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CODING HIV
Code V08 is used as long as the patient is
asymptomatic.
 Code 042 is used once the patient exhibits HIVrelated illnesses even when the patient may be
asymptomatic for a period of time (never go
back to V08).
 Code 795.71 is used for very limited situations
when an HIV test is inconclusive.
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HIV TESTING & COUNSELING
V73.89, Screening test for HIV
 V69.8, High risk group
 V65.44, HIV counseling
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V CODES
There are several V codes applicable to
infectious and parasitic diseases.
 These are found on page 83
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