ICD-10 Coding for Labial Herpes(B00.1, B00.2)
Complete ICD-10-CM coding and documentation guide for Labial Herpes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Labial Herpes
B00-B09Primary Range
Viral Infections Characterized by Skin and Mucous Membrane Lesions
This range includes herpesviral infections affecting the skin and mucous membranes, including labial herpes.
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 when vesicular lesions are confirmed on the lips or perioral area with HSV-1/2 confirmation. |
|
| B00.2 | Herpesviral gingivostomatitis and pharyngotonsillitis | Use when herpes lesions are present in the oral cavity or throat. |
|
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 labial herpes
Essential facts and insights about Labial Herpes
Primary ICD-10-CM Codes for labial herpes
Decision Criteria
clinical Criteria
- Presence of vesicular lesions on lips confirmed by PCR for HSV-1/2.
coding Criteria
- Avoid using B00.9 when specific HSV type is confirmed.
Applicable To
- Herpes labialis
Excludes
- Herpesviral infection of genitalia (A60.0)
Clinical Validation Requirements
- PCR or viral culture confirming HSV-1/2
- Lesion description: vesicles on lips or perioral area
Code-Specific Risks
- Risk of using unspecified codes when specific HSV type is confirmed.
Coding Notes
- Ensure documentation specifies HSV type and lesion location to avoid unspecified codes.
B00.2 - Herpesviral gingivostomatitis and pharyngotonsillitis
Use when herpes lesions are present in the oral cavity or throat.
Applicable To
- Oral herpes simplex
Excludes
- Herpesviral vesicular dermatitis (B00.1)
Clinical Validation Requirements
- Lesions involving oral mucosa or throat
- HSV confirmation via PCR or culture
Coding Notes
Ensure documentation specifies lesion location to differentiate from B00.1.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
Z77.22Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Labial Herpes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B00.1.
Impact
Clinical: May lead to incorrect treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Train staff on documentation requirements., Use templates for consistent documentation.
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies HSV type and lesion location.
Impact
Using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation includes all necessary details for specific coding.
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 Labial Herpes, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Labial Herpes
Use these documentation templates to ensure complete and accurate documentation for Labial Herpes. These templates include all required elements for proper coding and billing.
Patient presents with lip vesicles
Specialty: DermatologyRequired Elements
- Location of lesions
- Description of vesicles
- HSV test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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