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v1.0.0
ICD-10 Guide
ICD-10 CodesA38

A38

Scarlet fever

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

Code Description

ICD-10 A38 is a billable code used to indicate a diagnosis of scarlet fever.

Key Diagnostic Point:

Scarlet fever is an infectious disease caused by group A Streptococcus (Streptococcus pyogenes), characterized by a distinctive red rash, fever, and sore throat. The condition typically arises following a streptococcal throat infection, where the bacteria produce a toxin that leads to the characteristic rash. The rash usually appears 1-2 days after the onset of fever and sore throat, starting on the neck and face before spreading to the trunk and extremities. The skin may feel rough to the touch, resembling sandpaper. Other symptoms can include a 'strawberry tongue,' headache, abdominal pain, and nausea. Scarlet fever is most common in children aged 5 to 15 years, although it can occur in adults. Treatment primarily involves antibiotics, such as penicillin or amoxicillin, to eradicate the bacteria and prevent complications, including rheumatic fever and post-streptococcal glomerulonephritis. Prompt diagnosis and treatment are crucial to reduce the risk of transmission and complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between scarlet fever and other streptococcal infections.
  • Understanding the clinical presentation and associated symptoms.
  • Recognizing the need for antibiotic resistance patterns.
  • Documenting the presence of complications or co-infections.

Audit Risk Factors

  • Inadequate documentation of symptoms leading to misdiagnosis.
  • Failure to document antibiotic treatment and response.
  • Omission of patient age and relevant medical history.
  • Incorrect coding of complications or co-morbid conditions.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of symptoms, including rash description and fever onset.

Common Clinical Scenarios

Children presenting with sore throat, fever, and rash.

Billing Considerations

Consideration of family history of streptococcal infections and potential complications.

Infectious Disease

Documentation Requirements

Comprehensive documentation of laboratory results and antibiotic susceptibility.

Common Clinical Scenarios

Patients with recurrent infections or complications from untreated scarlet fever.

Billing Considerations

Monitoring for antibiotic resistance patterns and treatment efficacy.

Coding Guidelines

Inclusion Criteria

Use A38 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the clinical presentation and any complications

Exclusion Criteria

Do NOT use A38 When
  • Exclude codes for other streptococcal infections unless specifically documented

Related Codes

Child Codes

4 codes
A38.0
Scarlet fever
A38.1
Scarlet fever
A38.8
Other forms of tetanus
A38.9
Scarlet fever, unspecified

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits after initial diagnosis of scarlet fever.

Documentation Requirements

Document the patient's symptoms, treatment response, and any complications.

Specialty Considerations

Pediatricians should note growth and development in follow-up visits.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of scarlet fever, improving the accuracy of data collection and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scarlet fever, improving the accuracy of data collection and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of scarlet fever, improving the accuracy of data collection and treatment tracking.

Resources

Clinical References

  • •
    CDC - Scarlet Fever

Coding & Billing References

  • •
    CDC - Scarlet Fever

Frequently Asked Questions

What are the common symptoms of scarlet fever?

Common symptoms include a red rash, fever, sore throat, and a 'strawberry tongue.'

How is scarlet fever treated?

Scarlet fever is treated with antibiotics, typically penicillin or amoxicillin, to eliminate the infection.

Can adults get scarlet fever?

Yes, while scarlet fever is more common in children, adults can also contract the infection.