Antimicrobial Resistance

Definition

The resistance of micro-organisms like bacteria, viruses, fungi, and parasites to one or more classes of antimicrobial drugs.

Antimicrobial Resistance (AMR) can lead to the following: 

• Infections that last longer, lengthen hospital stays, and are more costly to treat
• A higher risk of disease spreading
• A greater chance of fatality due to infection 
• It is a natural process that happens over time through genetic changes in pathogens

*AMR is a top global public health threat and responsible for an estimated 1.27 million global deaths in 2019.*

Diagnostic Criteria

Definitively diagnosed using culture and sensitivity/susceptibility testing. Sensitivity testing demonstrates resistance to one or more drug classes. 

Sensitivity/Susceptibility results read as: 

• • S: Susceptible/sensitive—the organism is inhibited by the drug using the usual dosage 
  • I: Intermediate—the organism is inhibited, but only at the maximum recommended dosage 
  • R: Resistant—the organism is resistant to the achievable serum drug levels 
  • SD: Sensitive-dose dependent 
  • NI: No interpretation 

Coding Considerations

Resistance to antimicrobial drugs is classified under the Z16 category and are comorbid conditions (CCs). 

Categories include: 

• Resistance to beta lactam antibiotics (including Penicillin) 
• Resistance to other antibiotics (including Vancomycin and Vancomycin related antibiotics) 
• Resistance to other antimicrobial drugs (including Antiparasitic, Antiviral drugs) 

Instructional notes: 

• Code first the infection 
• The codes in this category are provided for use as additional codes to identify the resistance and non-responsiveness of a condition to antimicrobial drugs 

Excludes 1 note: 

Codes from this group should not be assigned with combination codes that identify both the infection and the drug resistance.

• • MRSA infection (A49.02) 
  • MRSA pneumonia (J15.212) 
  • Sepsis due to MRSA (A41.02) 

CDI Practice Considerations

High-risk AMR circumstances may include: 

• • Immunosuppression of any cause 
  • Indwelling catheters 
  • Ventilator status or recently ventilated 
  • Recent hospitalization 
  • Recent antibiotic use 

Most common drug-resistant organisms for inpatients: 

• • MRSA 
  • Enterococcus faecium 
  • Pneumococcus 
  • Klebsiella 
  • E. coli
  • Pseudomonas 
  • C. diff 
  • Acinetobacter 
  • Candida 

• A large percentage of those who contract AMR infections are immunocompromised. Review the record to capture this diagnosis if applicable.  

• Review the culture results thoroughly. The provider must document if an infection has become drug-resistant. If not, a query may be necessary. The Z16 codes cannot be taken just from the culture results. 

• Be alert to antibiotic changes. This may indicate the infection is resistant to current treatment.  

• If individual or multiple drugs to which an organism is resistant are documented by the clinician, a code is assigned for each drug identified. 

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