Back to HomeBeta

ICD-10 Coding for Herpes Simplex Virus 1(B00.1, B00.2)

Complete ICD-10-CM coding and documentation guide for Herpes Simplex Virus 1. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

HSV-1Oral HerpesCold SoresHerpes Labialis

Quick Navigation

Related ICD-10 Code Ranges

Complete code families applicable to Herpes Simplex Virus 1

B00.0-B00.9Primary Range

Herpesviral [herpes simplex] infections

This range includes all herpes simplex infections, with specific codes for different manifestations of HSV-1.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
B00.1Herpesviral vesicular dermatitisUse for oral HSV-1 infections presenting as vesicular lesions on the lips or face.
  • PCR test positive for HSV-1
  • Viral culture confirming HSV-1
B00.2Herpesviral gingivostomatitis and pharyngotonsillitisUse for severe oral mucosal involvement with gingival inflammation.
  • Viral culture confirming HSV-1
  • Clinical presentation of gingival inflammation

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 simplex 1

Essential facts and insights about Herpes Simplex Virus 1

The ICD-10 code for herpes simplex 1, particularly for oral herpes, is B00.1.

Primary ICD-10-CM Codes for herpes simplex 1

B00.1
Herpesviral vesicular dermatitis
Billable Code

Decision Criteria

clinical Criteria

  • Presence of vesicular lesions on the lips confirmed by PCR for HSV-1.

documentation Criteria

  • Explicit mention of HSV-1 and lesion location in the medical record.

Applicable To

  • Herpes labialis
  • Cold sores

Excludes

  • Anogenital herpes (A60.-)

Clinical Validation Requirements

  • PCR test positive for HSV-1
  • Viral culture confirming HSV-1

Code-Specific Risks

  • Confusing with genital herpes codes
  • Using without site specification

Coding Notes

  • Ensure documentation specifies HSV-1 and the site of infection.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Encounter for immunization

Z23
Use if vaccination counseling occurs during the same encounter.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Anogenital herpesviral infection

A60.0
Use for genital lesions; differentiate by anatomic site and HSV type.

Herpangina

B08.5
Use for oral lesions caused by Coxsackievirus, not HSV.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Herpes Simplex Virus 1 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B00.1.

Impact

Clinical: Potential misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Claim denials due to lack of specificity.

Mitigation Strategy

Train staff on documentation standards, Use templates with required fields

Impact

Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate health records and statistics.

Mitigation Strategy

Use A60.0- codes for genital herpes.

Impact

Failure to specify HSV type can lead to audit issues.

Mitigation Strategy

Require lab confirmation of HSV type in documentation.

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 Simplex Virus 1, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Herpes Simplex Virus 1

Use these documentation templates to ensure complete and accurate documentation for Herpes Simplex Virus 1. These templates include all required elements for proper coding and billing.

Primary Care Progress Note (Acute Episode)

Specialty: Family Medicine

Required Elements

  • Subjective history
  • Objective findings
  • Assessment
  • Plan

Example Documentation

**Subjective**: Pt reports 3-day history of painful lip blisters, recurrence x4/year. **Objective**: - 2×3 mm grouped vesicles on right upper lip - Tzanck smear positive for multinucleated giant cells - HSV-1 PCR pending **Assessment**: Recurrent herpes labialis (HSV-1), episode #4 this year **Plan**: Valacyclovir 2g PO x1, then 1g BID x7d

Examples: Poor vs. Good Documentation

Poor Documentation Example
Oral blisters, no etiology specified.
Good Documentation Example
3-mm clustered vesicles on lower lip margins, HSV-1 IgG positive.
Explanation
The good example specifies the lesion location and confirms HSV-1, meeting documentation requirements.

Need help with ICD-10 coding for Herpes Simplex Virus 1? Ask your questions below.

Ask about any ICD-10 CM code, or paste a medical note

We build tools for
clinician happiness.

Learn More at Freed.ai
Back to HomeBeta

Built by Freed

Try Freed for free for 7 days.

Learn more

Helpful Links

How ICD 10 AI Lookup WorksContact UsPrivacy Policy