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v1.0.0
ICD-10 Guide
ICD-10 CodesA26.0

A26.0

Erysipelas caused by group A streptococcus

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

Code Description

ICD-10 A26.0 is a billable code used to indicate a diagnosis of erysipelas caused by group a streptococcus.

Key Diagnostic Point:

Erysipelas is a bacterial skin infection characterized by a well-defined, raised, and red area of skin, often accompanied by fever and chills. It is primarily caused by group A Streptococcus (Streptococcus pyogenes), which is a common pathogen responsible for various infections, including pharyngitis and cellulitis. Erysipelas typically affects the face and lower extremities and can occur following skin trauma or in patients with predisposing factors such as diabetes, obesity, or venous insufficiency. The infection is marked by rapid onset and can lead to systemic symptoms. Diagnosis is usually clinical, supported by laboratory tests to confirm the presence of the bacteria. Treatment involves antibiotics, and in severe cases, hospitalization may be required. Public health considerations include the need for proper hygiene and wound care to prevent transmission and outbreaks, especially in communal living settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating erysipelas from other skin infections like cellulitis.
  • Understanding the specific causative organism (group A streptococcus).
  • Identifying predisposing factors that may complicate the diagnosis.
  • Documenting clinical symptoms accurately to support the diagnosis.

Audit Risk Factors

  • Inadequate documentation of clinical symptoms.
  • Failure to specify the causative organism.
  • Misclassification of erysipelas as cellulitis.
  • Lack of supporting laboratory results.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical history, laboratory results confirming streptococcal infection, and treatment response.

Common Clinical Scenarios

Patients presenting with fever, chills, and localized skin redness.

Billing Considerations

Consideration of antibiotic resistance patterns and patient history.

Dermatology

Documentation Requirements

Photographic evidence of skin lesions, detailed descriptions of the rash, and patient history.

Common Clinical Scenarios

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

Billing Considerations

Differentiating erysipelas from other dermatological conditions.

Coding Guidelines

Inclusion Criteria

Use A26.0 When
  • Follow ICD
  • CM guidelines for coding infectious diseases
  • Include documentation of the causative organism and any relevant clinical findings
  • Ensure that the code reflects the specific type of infection and its severity

Exclusion Criteria

Do NOT use A26.0 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when a patient with erysipelas is seen for follow-up care.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Infectious disease specialists may require more detailed documentation.

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 the accuracy of data collection and reimbursement processes. It emphasizes the importance of documenting the causative organism and clinical presentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving the accuracy of data collection and reimbursement processes. It emphasizes the importance of documenting the causative organism and clinical presentation.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the importance of documenting the causative organism and clinical presentation.

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 group A streptococcus, a type of bacteria that can enter the skin through cuts or abrasions.