MRSA Nasal Colonization Management

Diagnosis and Coding

The Centers for Disease Control and Prevention recommends using ICD-10 code Z22.322 to cover mupirocin ointment for MRSA nasal colonization, which directly corresponds to nasal colonization with MRSA and justifies the use of intranasal mupirocin for decolonization 1, 2.
Decolonization is indicated when a patient has confirmed MRSA nasal colonization, particularly in the context of recurrent skin infections or prior to surgical procedures, as suggested by the Infectious Diseases Society of America 3, 1.
The standard regimen for nasal decolonization is intranasal mupirocin 2% applied twice daily for 5-10 days, as recommended by the Clinical Infectious Diseases guidelines 1, 2, 4.

For surgical patients, the American Society of Anesthesiologists recommends nasal decolonization with mupirocin starting at least 48 hours before surgery and continuing for 5-7 days total to decrease postoperative infections 5.

The Centers for Medicare and Medicaid Services suggests using code Z22.321 if the patient has MSSA rather than MRSA colonization, though mupirocin is still appropriate 4.
The American Academy of Dermatology recommends considering adding code L08.9 if there is active or recurrent skin infection in addition to colonization, and code L02.xx for recurrent abscesses that prompted the decolonization strategy 3, 2, 6.
The Infectious Diseases Society of America advises ensuring medical records clearly document positive MRSA nasal culture or screening results to support the Z22.322 code, and avoiding infection codes for colonization alone 1, 2.
For recurrent infections, the Clinical Infectious Diseases guidelines suggest using both Z22.322 and the appropriate infection code (e.g., L02.xx for recurrent abscesses) 3, 6.