ICD-10 Coding for Herpes Gingivostomatitis(B00.2, B00.1)
Complete ICD-10-CM coding and documentation guide for Herpes Gingivostomatitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herpes Gingivostomatitis
B00-B09Primary Range
Viral infections characterized by skin and mucous membrane lesions
This range includes codes for herpesviral infections affecting the oral cavity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B00.2 | Herpesviral gingivostomatitis and pharyngotonsillitis | Use when herpesviral infection is confirmed in the oral cavity. |
|
| B00.1 | Herpesviral vesicular dermatitis | Use when herpesviral infection is confirmed on skin outside the oral cavity. |
|
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 herpes gingivostomatitis
Essential facts and insights about Herpes Gingivostomatitis
Primary ICD-10-CM Codes for herpes gingivostomatitis
Decision Criteria
clinical Criteria
- Presence of oral vesicles and systemic symptoms
documentation Criteria
- Positive HSV-1 PCR or viral culture
Applicable To
- Herpesviral infection of the oral cavity
- Herpesviral pharyngitis
Excludes
- Anogenital herpesviral infection (A60.-)
Clinical Validation Requirements
- Presence of oral vesicles and ulcers
- Systemic symptoms such as fever and lymphadenopathy
- Positive HSV-1 PCR or viral culture
Code-Specific Risks
- Risk of using unspecified codes leading to reimbursement issues
Coding Notes
- Ensure documentation specifies oral involvement to avoid ambiguity with genital herpes codes.
B00.1 - Herpesviral vesicular dermatitis
Use when herpesviral infection is confirmed on skin outside the oral cavity.
Applicable To
- Herpes simplex dermatitis
Excludes
- Herpesviral infection of the oral cavity (B00.2)
Clinical Validation Requirements
- Presence of vesicular lesions on skin, not limited to oral cavity
Coding Notes
Differentiate from oral herpes by confirming lesion location.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Herpes Gingivostomatitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B00.2.
Impact
Clinical: May lead to misdiagnosis, Regulatory: Non-compliance with documentation standards, Financial: Potential for claim denials
Mitigation Strategy
Use specific terminology for lesion description, Include lab results in documentation
Impact
Reimbursement: May lead to denials due to lack of specificity, Compliance: Non-compliance with coding guidelines, Data Quality: Reduces accuracy of clinical data
Mitigation Strategy
Specify oral involvement to use B00.2
Impact
High denial rates for unspecified herpes codes
Mitigation Strategy
Ensure documentation specifies oral vs. genital involvement
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 Herpes Gingivostomatitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herpes Gingivostomatitis
Use these documentation templates to ensure complete and accurate documentation for Herpes Gingivostomatitis. These templates include all required elements for proper coding and billing.
Pediatric presentation with oral ulcers
Specialty: PediatricsRequired Elements
- Chief complaint
- History of present illness
- Physical exam findings
- Laboratory results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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