ICD-10 Coding for Mupirocin in MRSA Nasal Colonization
Use ICD-10 code Z22.322 (Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus) to cover mupirocin ointment for MRSA nasal colonization.
Primary Diagnosis Code
- Z22.322 is the specific code for MRSA carrier status, which directly corresponds to nasal colonization with MRSA and justifies the use of intranasal mupirocin for decolonization 1.
Clinical Context Supporting This Code
The use of mupirocin for MRSA nasal decolonization is well-established in clinical guidelines:
Decolonization is indicated when a patient has confirmed MRSA nasal colonization, particularly in the context of recurrent skin infections or prior to surgical procedures 1.
Standard regimen: Intranasal mupirocin 2% applied twice daily for 5-10 days is the recommended approach for nasal decolonization 1, 2.
Preoperative decolonization: For surgical patients, nasal decolonization with mupirocin starting at least 48 hours before surgery and continuing for 5-7 days total is recommended to decrease postoperative infections 1.
Alternative or Additional Codes to Consider
Z22.321 (Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus) - Use this if the patient has MSSA rather than MRSA colonization, though mupirocin is still appropriate 2.
L08.9 (Local infection of skin and subcutaneous tissue, unspecified) - Consider adding this code if there is active or recurrent skin infection in addition to colonization 1.
L02.xx (Cutaneous abscess, furuncle and carbuncle) - Use the appropriate site-specific code if the patient has recurrent abscesses that prompted the decolonization strategy 1.
Important Coding Considerations
Document colonization status: Ensure medical records clearly document positive MRSA nasal culture or screening results to support the Z22.322 code 1.
Avoid infection codes for colonization alone: Do not use infection codes (like A49.02 for MRSA infection) if the patient only has colonization without active infection 1.
For recurrent infections: If mupirocin is being prescribed as part of a decolonization strategy for recurrent MRSA skin infections, you may use both Z22.322 and the appropriate infection code (e.g., L02.xx for recurrent abscesses) 1.
Clinical Pitfalls
Resistance concerns: Be aware that mupirocin resistance (particularly high-level resistance) can lead to treatment failure, so routine decolonization without confirmed colonization is not recommended 3, 4.
Duration matters: The 10-dose regimen (twice daily for 5 days) is superior to shorter regimens for maintaining decolonization 5.
Multisite colonization: Nasal mupirocin alone may be only marginally effective if MRSA colonization exists at multiple body sites; consider adding chlorhexidine body washes for comprehensive decolonization 1, 6.