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v1.0.0
ICD-10 Guide
ICD-10 CodesA26

A26

Erysipelas

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 A26 is a billable code used to indicate a diagnosis of erysipelas.

Key Diagnostic Point:

Erysipelas is a bacterial skin infection characterized by a well-defined, raised, and red area of skin, typically affecting the face and legs. It is primarily caused by Streptococcus pyogenes, a type of bacteria that can enter the body through breaks in the skin. The infection often presents with symptoms such as fever, chills, and localized pain or tenderness. Erysipelas is distinct from cellulitis, as it involves the upper dermis and superficial lymphatics, leading to a more pronounced inflammatory response. The condition can occur in healthy individuals but is more common in those with compromised immune systems, chronic skin conditions, or lymphatic obstruction. Transmission is not zoonotic; instead, it is spread through direct contact with infected skin or respiratory droplets. Public health considerations include the importance of hygiene and wound care to prevent outbreaks, especially in vulnerable populations. Prompt diagnosis and treatment with antibiotics are crucial to prevent complications such as abscess formation or systemic infection.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating erysipelas from cellulitis and other skin infections
  • Understanding the specific clinical presentation and symptoms
  • Documenting the site of infection accurately
  • Recognizing the need for antibiotic therapy and its implications

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the site of infection
  • Misclassification of erysipelas as cellulitis
  • Lack of documentation for underlying conditions

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on the infection's progression and treatment response.

Common Clinical Scenarios

Patients presenting with fever and localized skin redness.

Billing Considerations

Ensure documentation reflects the severity and any comorbidities.

Dermatology

Documentation Requirements

Photographic evidence of skin lesions and detailed descriptions.

Common Clinical Scenarios

Patients with recurrent skin infections or those with chronic skin conditions.

Billing Considerations

Document any previous skin conditions that may contribute to the current diagnosis.

Coding Guidelines

Inclusion Criteria

Use A26 When
  • Follow official ICD
  • CM guidelines for coding infectious diseases, ensuring accurate documentation of the site and severity of the infection
  • Include any relevant comorbidities

Exclusion Criteria

Do NOT use A26 When
No specific exclusions found.

Related Codes

Child Codes

4 codes
A26.0
Erysipelas caused by group A streptococcus
A26.7
Erysipelothrix sepsis
A26.8
Other specified leptospirosis
A26.9
Erysipelas, unspecified

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits after initial diagnosis of erysipelas.

Documentation Requirements

Document the patient's progress and response to treatment.

Specialty Considerations

Infectious disease specialists may require more detailed notes on treatment efficacy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving data accuracy and facilitating better tracking of infection rates and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving data accuracy and facilitating better tracking of infection rates and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving data accuracy and facilitating better tracking of infection rates and treatment outcomes.

Resources

Clinical References

  • •
    CDC Erysipelas Information

Coding & Billing References

  • •
    CDC Erysipelas Information

Frequently Asked Questions

What is the primary cause of erysipelas?

Erysipelas is primarily caused by Streptococcus pyogenes, a type of bacteria that can enter through breaks in the skin.

How can erysipelas be differentiated from cellulitis?

Erysipelas typically presents with well-defined borders and is confined to the upper dermis, while cellulitis has less defined borders and affects deeper layers of the skin.