ICD-10 Coding for Epstein-Barr Virus(B27.00, B97.21)
Complete ICD-10-CM coding and documentation guide for Epstein-Barr Virus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epstein-Barr Virus
B27Primary Range
Infectious mononucleosis
This range includes codes for infectious mononucleosis, primarily caused by Epstein-Barr virus.
Viral agents as the cause of diseases classified elsewhere
This range includes codes for identifying the viral agent, such as EBV, when it is the cause of other diseases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B27.00 | Gammaherpesviral mononucleosis without complications | Use when EBV is confirmed by serology or PCR with mononucleosis symptoms. |
|
| B97.21 | Epstein-Barr virus as the cause of diseases classified elsewhere | Use to indicate EBV as the causative agent in conditions like myocarditis. |
|
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 Epstein-Barr virus
Essential facts and insights about Epstein-Barr Virus
Primary ICD-10-CM Codes for epstein–barr virus
Decision Criteria
clinical Criteria
- Presence of EBV-specific antibodies or positive PCR test.
documentation Criteria
- Detailed documentation of symptoms and lab results confirming EBV.
Applicable To
- Chronic active EBV infection
- Epstein-Barr virus disease
Excludes
- Cytomegaloviral mononucleosis (B27.1)
Clinical Validation Requirements
- Positive VCA IgM ≥44 U/mL
- EBNA IgG negative
- Lymphocytosis >50%
Code-Specific Risks
- Incorrectly using B27 when EBV is confirmed.
Coding Notes
- Ensure documentation specifies EBV confirmation through lab tests.
B97.21 - Epstein-Barr virus as the cause of diseases classified elsewhere
Use to indicate EBV as the causative agent in conditions like myocarditis.
Clinical Validation Requirements
- Positive EBV PCR in sterile site
- Organ-specific symptoms
Coding Notes
Always use as a secondary code with a primary manifestation code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Epstein-Barr virus as the cause of diseases classified elsewhere
B97.21Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Epstein-Barr Virus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B27.00.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Ensure lab confirmation of EBV is documented., Use specific ICD-10 codes.
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure EBV confirmation is documented to use B27.00.
Impact
Risk of using non-specific codes for EBV.
Mitigation Strategy
Regular training on ICD-10 updates and documentation standards.
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 Epstein-Barr Virus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epstein-Barr Virus
Use these documentation templates to ensure complete and accurate documentation for Epstein-Barr Virus. These templates include all required elements for proper coding and billing.
Acute EBV Mononucleosis
Specialty: Infectious DiseaseRequired Elements
- Chief Complaint
- EBV Testing Results
- Physical Findings
- Assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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