ICD-10 Coding for Oral Herpes(B00.1, B00.2)
Complete ICD-10-CM coding and documentation guide for Oral Herpes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Oral Herpes
B00-B09Primary Range
Viral infections characterized by skin and mucous membrane lesions
This range includes all herpesviral infections, with specific codes for oral manifestations.
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 confirmed cases of herpes labialis with vesicular lesions on the lips. |
|
| B00.2 | Herpesviral gingivostomatitis and pharyngotonsillitis | Use for confirmed cases with lesions on the gingiva or pharynx. |
|
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 Oral Herpes
Primary ICD-10-CM Codes for oral herpes
Decision Criteria
clinical Criteria
- Presence of vesicular lesions on the lip border
documentation Criteria
- PCR confirmation of HSV-1
Applicable To
- Herpes labialis
Excludes
- Gingivostomatitis (B00.2)
Clinical Validation Requirements
- PCR confirmation of HSV-1
- Clinical presentation of vesicular lesions on the lips
Code-Specific Risks
- Misclassification if lesion location is not specified
Coding Notes
- Ensure lesion location is documented to avoid using unspecified codes.
B00.2 - Herpesviral gingivostomatitis and pharyngotonsillitis
Use for confirmed cases with lesions on the gingiva or pharynx.
Applicable To
- Herpesviral pharyngotonsillitis
Excludes
- Herpes labialis (B00.1)
Clinical Validation Requirements
- PCR confirmation of HSV-1 or HSV-2
- Clinical presentation of ulcers on gingiva or pharynx
Coding Notes
Ensure lesion location is documented to avoid using unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Oral 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 for denied claims due to lack of specificity.
Mitigation Strategy
Train staff on detailed documentation practices.
Impact
Reimbursement: May result in lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure specific lesion location and type are documented to use B00.1 or B00.2.
Impact
Using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure detailed documentation of lesion location and 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 Oral Herpes, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Oral Herpes
Use these documentation templates to ensure complete and accurate documentation for Oral Herpes. These templates include all required elements for proper coding and billing.
Recurrent herpes labialis
Specialty: DermatologyRequired Elements
- Lesion description
- Location
- PCR results
- Recurrence status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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