ICD-10 Coding for Cytomegalovirus(B25.0, B25.8, B25.9, P35.1)
Complete ICD-10-CM coding and documentation guide for Cytomegalovirus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cytomegalovirus
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B25.0 | Cytomegaloviral pneumonitis | Use when CMV is confirmed as the cause of pneumonitis. |
|
| B25.8 | Other cytomegaloviral diseases | Use for CMV diseases not specified elsewhere, like colitis. |
|
| B25.9 | Cytomegaloviral disease, unspecified | Use when CMV is confirmed but specific manifestation is not documented. |
|
| P35.1 | Congenital cytomegalovirus infection | Use for neonates diagnosed with CMV within the first 21 days of life. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for cytomegalovirus
Essential facts and insights about Cytomegalovirus
Primary ICD-10-CM Codes for cytomegalovirus
Decision Criteria
clinical Criteria
- Confirmed CMV infection with respiratory symptoms
Applicable To
- CMV pneumonia
Excludes
- Pneumonia due to other viruses
Clinical Validation Requirements
- Positive CMV PCR in bronchoalveolar lavage
- Radiological evidence of pneumonia
Code-Specific Risks
- Misclassification if not confirmed by lab results
Coding Notes
- Ensure documentation specifies CMV as the cause of pneumonitis.
B25.8 - Other cytomegaloviral diseases
Use for CMV diseases not specified elsewhere, like colitis.
Applicable To
- CMV colitis
Excludes
- Colitis due to other causes
Clinical Validation Requirements
- Biopsy showing CMV inclusions
- Positive CMV PCR in stool
Coding Notes
Documentation must link CMV to the colitis diagnosis.
B25.9 - Cytomegaloviral disease, unspecified
Use when CMV is confirmed but specific manifestation is not documented.
Applicable To
- CMV infection NOS
Excludes
- Specific CMV manifestations
Clinical Validation Requirements
- Positive CMV PCR without specific organ involvement
Coding Notes
Ensure no specific manifestation is documented before using this code.
P35.1 - Congenital cytomegalovirus infection
Use for neonates diagnosed with CMV within the first 21 days of life.
Applicable To
- Congenital CMV
Excludes
- Acquired CMV infections
Clinical Validation Requirements
- Positive CMV PCR in neonate within 21 days of birth
Coding Notes
Ensure documentation specifies congenital infection.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cytomegalovirus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B25.0.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Review clinical documentation, Use specific codes
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always sequence the CMV code before manifestation codes.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Fails to meet specificity requirements., Data Quality: Reduces the accuracy of health records.
Mitigation Strategy
Use specific CMV codes when manifestations are documented.
Impact
Audits may focus on the specificity of CMV-related codes.
Mitigation Strategy
Ensure detailed documentation and use of specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Cytomegalovirus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cytomegalovirus
Use these documentation templates to ensure complete and accurate documentation for Cytomegalovirus. These templates include all required elements for proper coding and billing.
CMV colitis in immunocompromised patient
Specialty: GastroenterologyRequired Elements
- Biopsy results
- PCR viral load
- Clinical symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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