ICD-10 Coding for Herpes Simplex Virus in Pregnancy(O26.43, Z86.59)
Complete ICD-10-CM coding and documentation guide for Herpes Simplex Virus in Pregnancy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herpes Simplex Virus in Pregnancy
O26.4Primary Range
Maternal care for other conditions predominantly related to pregnancy
This range includes codes for herpes simplex virus infections complicating pregnancy.
Herpesviral [herpes simplex] infections
This range includes codes for herpes simplex infections, which may be used as secondary codes.
Personal history of diseases of the genitourinary system
This range includes codes for a history of genital herpes without current complications.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| O26.43 | Herpes gestationis, third trimester | Use when active HSV lesions are present during the third trimester of pregnancy. |
|
| Z86.59 | Personal history of other diseases of the genitourinary system | Use when there is a history of HSV without current active infection. |
|
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 virus in pregnancy
Essential facts and insights about Herpes Simplex Virus in Pregnancy
Primary ICD-10-CM Codes for herpes simplex virus in pregnancy
Decision Criteria
clinical Criteria
- Active HSV lesions confirmed by laboratory tests
documentation Criteria
- Gestational age documented as third trimester
Applicable To
- Active herpes simplex virus infection during the third trimester
Excludes
- History of herpes without current infection (Z86.59)
Clinical Validation Requirements
- Presence of active HSV lesions confirmed by PCR
- Gestational age documented as third trimester
Code-Specific Risks
- Incorrectly coding asymptomatic history as active infection
Coding Notes
- Ensure documentation specifies active lesions and trimester.
Z86.59 - Personal history of other diseases of the genitourinary system
Use when there is a history of HSV without current active infection.
Applicable To
- History of genital herpes without current infection
Excludes
- Active herpes simplex virus infection (O26.43)
Clinical Validation Requirements
- Documentation of past HSV infection without current symptoms
Coding Notes
Ensure documentation clearly states history without current symptoms.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
39 weeks gestation of pregnancy
Z3A.39Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Herpes Simplex Virus in Pregnancy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code O26.43.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential reimbursement issues
Mitigation Strategy
Always include gestational age in weeks, Use templates to ensure completeness
Impact
Reimbursement: Incorrect reimbursement due to misclassification., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use Z86.59 for history without current symptoms.
Impact
Using O26.43 for historical HSV cases.
Mitigation Strategy
Ensure documentation supports active infection.
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 in Pregnancy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herpes Simplex Virus in Pregnancy
Use these documentation templates to ensure complete and accurate documentation for Herpes Simplex Virus in Pregnancy. These templates include all required elements for proper coding and billing.
Active HSV infection in third trimester
Specialty: ObstetricsRequired Elements
- Gestational age
- Presence and description of lesions
- Lab confirmation
- Antiviral treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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