A31.0

HCC Category Mapping

What This Code Means

This is a bacterial lung infection caused by mycobacteria (a type of bacteria), which is different from the more common tuberculosis. It affects the lungs and respiratory system, causing symptoms like cough and breathing difficulties.

Coding Tips

• •Verify the specific type of mycobacterial infection (such as MAC - Mycobacterium avium complex) as this may require additional specificity codes
• •Confirm whether this is a primary infection or a secondary/opportunistic infection, particularly in immunocompromised patients, as this may affect coding accuracy

Clinical Significance

Pulmonary mycobacterial infection (nontuberculous mycobacteria, or NTM) is a chronic progressive lung disease most commonly caused by Mycobacterium avium complex (MAC) or M. abscessus. It predominantly affects elderly women with bronchiectasis (Lady Windermere syndrome) and immunocompromised patients, requiring prolonged multi-drug treatment regimens often lasting 12-18 months.

Documentation Requirements

• ✓Sputum cultures identifying specific NTM species (at least 2 positive sputum cultures, or 1 positive bronchial wash/BAL)
• ✓CT chest showing nodular bronchiectatic or cavitary disease pattern
• ✓Clinical symptoms consistent with pulmonary NTM (chronic cough, fatigue, weight loss)
• ✓Exclusion of other diagnoses, particularly pulmonary tuberculosis
• ✓ATS/IDSA diagnostic criteria met: clinical, radiographic, and microbiologic criteria all fulfilled

Commonly Confused Codes