ICD-10 Coding for Herpes Simplex(B00.1, A60.04)
Complete ICD-10-CM coding and documentation guide for Herpes Simplex. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herpes Simplex
B00.0-B00.9Primary Range
Herpesviral [herpes simplex] infections
This range covers various manifestations of herpes simplex infections, including vesicular dermatitis, meningitis, and unspecified forms.
Anogenital herpesviral [herpes simplex] infections
This range is specific to anogenital herpes infections, including vulvovaginitis and perianal herpes.
Congenital herpesviral [herpes simplex] infection
This code is used for congenital herpes infections, which are excluded from the B00 range.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B00.1 | Herpesviral vesicular dermatitis | Use for facial/oral lesions with vesicular rash confirmed by PCR/viral culture. |
|
| A60.04 | Herpesviral vulvovaginitis | Use for genital herpes with vaginal involvement confirmed by culture. |
|
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 oral herpes
Essential facts and insights about Herpes Simplex
Primary ICD-10-CM Codes for herpes simplex
Decision Criteria
clinical Criteria
- Presence of vesicular rash on lips with positive HSV-1 PCR
Applicable To
- Cold sores
- Herpes labialis
Excludes
- Congenital herpesviral infection (P35.2)
Clinical Validation Requirements
- Vesicular rash confirmed by PCR or viral culture
Code-Specific Risks
- Misclassification if location is not specified
Coding Notes
- Ensure documentation specifies the anatomical site and confirms HSV type.
A60.04 - Herpesviral vulvovaginitis
Use for genital herpes with vaginal involvement confirmed by culture.
Applicable To
- Genital herpes with vaginal involvement
Excludes
- Congenital herpesviral infection (P35.2)
Clinical Validation Requirements
- Genital lesions confirmed by HSV-2 culture
Coding Notes
Ensure documentation specifies genital involvement and confirms HSV type.
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 Simplex to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B00.1.
Impact
Clinical: Impacts treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Use templates that prompt for HSV type, Educate providers on documentation standards
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces data accuracy for clinical research.
Mitigation Strategy
Document the specific location and type of HSV to use a more specific code.
Impact
High risk of audit for using unspecified codes.
Mitigation Strategy
Ensure detailed documentation of lesion location and HSV type.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herpes Simplex
Use these documentation templates to ensure complete and accurate documentation for Herpes Simplex. These templates include all required elements for proper coding and billing.
Recurrent oral herpes
Specialty: DermatologyRequired Elements
- Lesion location
- Lesion characteristics
- Testing results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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