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v1.0.0
ICD-10 Guide
ICD-10 CodesA26.9

A26.9

Erysipelas, unspecified

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

Code Description

ICD-10 A26.9 is a billable code used to indicate a diagnosis of erysipelas, unspecified.

Key Diagnostic Point:

Erysipelas is a bacterial skin infection characterized by a well-defined, raised, red area of skin that is often warm and painful. It is primarily caused by Streptococcus pyogenes, a type of bacteria that can enter the body through breaks in the skin. The condition typically presents with fever, chills, and malaise, and the affected area may exhibit swelling and tenderness. Erysipelas is often confused with cellulitis, but it is distinguished by its more superficial involvement of the skin and lymphatic vessels. The infection can occur in any part of the body but is most commonly seen on the face and legs. While it is not classified as a zoonotic infection, understanding its transmission vectors is crucial for public health. The bacteria can be transmitted through direct contact with infected individuals or contaminated surfaces. Public health measures focus on hygiene and wound care to prevent outbreaks, especially in vulnerable populations such as the elderly or those with compromised immune systems. Prompt diagnosis and treatment with antibiotics are essential to prevent complications such as abscess formation or systemic infection.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from similar conditions like cellulitis.
  • Need for clear documentation of symptoms and clinical findings.
  • Potential for misdiagnosis due to overlapping symptoms with other skin infections.
  • Variability in presentation based on patient demographics and comorbidities.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the location of the infection.
  • Misclassification with other skin infections.
  • Lack of supporting evidence for diagnosis in the medical record.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and treatment plans.

Common Clinical Scenarios

Patients presenting with fever and localized skin redness.

Billing Considerations

Consideration of patient history, including recent infections or skin trauma.

Dermatology

Documentation Requirements

Photographic evidence of skin lesions and detailed descriptions of the rash.

Common Clinical Scenarios

Diagnosis of erysipelas in patients with chronic skin conditions.

Billing Considerations

Differentiation from other dermatological conditions such as dermatitis or cellulitis.

Coding Guidelines

Inclusion Criteria

Use A26.9 When
  • Follow official coding guidelines for infectious diseases, ensuring accurate documentation of the diagnosis and any associated symptoms
  • Include relevant patient history and treatment plans

Exclusion Criteria

Do NOT use A26.9 When
No specific exclusions found.

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 patient history, examination findings, and treatment response.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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 bacterium that can enter the body through breaks in the skin.

How can erysipelas be differentiated from cellulitis?

Erysipelas is characterized by a well-defined, raised border and primarily affects the upper layers of the skin, while cellulitis involves deeper layers and has less defined borders.