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v1.0.0
ICD-10 Guide
ICD-10 CodesA38.9

A38.9

Scarlet fever, unspecified

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

Code Description

ICD-10 A38.9 is a billable code used to indicate a diagnosis of scarlet fever, unspecified.

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 rash typically appears within 12 to 48 hours after the onset of fever and is often described as feeling like sandpaper. The condition is most common in children aged 5 to 15 years but can occur in individuals of any age. Scarlet fever is transmitted through respiratory droplets and can also spread through contact with contaminated surfaces. While the disease is generally mild and treatable with antibiotics, complications such as rheumatic fever or post-streptococcal glomerulonephritis can arise if left untreated. Diagnosis is primarily clinical, supported by throat culture or rapid antigen detection tests. Treatment typically involves penicillin or amoxicillin, with alternatives for those allergic to penicillin. The prognosis is excellent with appropriate treatment, but awareness of potential complications is crucial for effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation among patients
  • Need for differential diagnosis with other streptococcal infections
  • Potential for complications requiring additional coding
  • Documentation of antibiotic treatment and response

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document antibiotic treatment
  • Misdiagnosis or lack of differential diagnosis
  • Inconsistent coding of complications

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of symptoms, physical examination findings, and treatment plan.

Common Clinical Scenarios

Diagnosis of scarlet fever in children presenting with fever and rash.

Billing Considerations

Consideration of age-related factors and potential complications in children.

Infectious Disease

Documentation Requirements

Comprehensive history of exposure, laboratory results, and treatment response.

Common Clinical Scenarios

Management of complicated cases or recurrent infections.

Billing Considerations

Need for thorough documentation of antibiotic resistance patterns.

Coding Guidelines

Inclusion Criteria

Use A38.9 When
  • Follow ICD
  • CM coding guidelines for infectious diseases
  • 9 should be used when the diagnosis of scarlet fever is confirmed but not specified further
  • Ensure to document the clinical findings and treatment provided

Exclusion Criteria

Do NOT use A38.9 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 and treatment of scarlet fever.

Documentation Requirements

Document symptoms, treatment response, and any complications.

Specialty Considerations

Pediatricians should note growth and development in follow-up.

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 ability to track and manage cases effectively. It has also enhanced the granularity of data for public health monitoring.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scarlet fever, improving the ability to track and manage cases effectively. It has also enhanced the granularity of data for public health monitoring.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of scarlet fever, improving the ability to track and manage cases effectively. It has also enhanced the granularity of data for public health monitoring.

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.' The rash typically feels like sandpaper and may start on the neck and face before spreading.