ICD-10 Guide

A43.0

Whooping cough due to Bordetella pertussis

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/05/2025

Code Description

ICD-10 A43.0 is a billable code used to indicate a diagnosis of whooping cough due to bordetella pertussis.

Key Diagnostic Point:

Whooping cough, or pertussis, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Characterized by severe coughing fits that can lead to a 'whooping' sound during inhalation, this condition poses significant risks, particularly in immunocompromised patients. In these individuals, the disease may present atypically, complicating diagnosis and management. The cough can be persistent and debilitating, leading to complications such as pneumonia, seizures, and even death in severe cases. Diagnostic challenges arise due to the need for specific laboratory tests, such as PCR or culture, to confirm the presence of Bordetella pertussis, especially in vaccinated populations where symptoms may be milder. Additionally, the clinical presentation can mimic other respiratory infections, making it essential for healthcare providers to maintain a high index of suspicion, particularly in vulnerable populations. Effective management includes supportive care and, in some cases, antibiotics, which can reduce transmission if administered early in the course of the illness.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Differential diagnosis with other respiratory infections
Variability in clinical presentation, especially in vaccinated individuals
Need for specific laboratory confirmation
Potential complications in immunocompromised patients

Audit Risk Factors

Inadequate documentation of laboratory results
Failure to document immunization status
Misdiagnosis due to overlapping symptoms with other conditions
Lack of detailed patient history regarding exposure

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of vaccination status, exposure to infected individuals, and symptom onset.

Common Clinical Scenarios

Infants presenting with severe cough, particularly those under 1 year of age.

Billing Considerations

Consideration of maternal vaccination history and potential for transmission.

Infectious Disease

Documentation Requirements

Comprehensive lab results, including PCR and culture, and detailed patient history.

Common Clinical Scenarios

Immunocompromised patients presenting with atypical respiratory symptoms.

Billing Considerations

Need for thorough investigation of potential outbreaks in vulnerable populations.

Coding Guidelines

Inclusion Criteria

Use A43.0 When

Follow official ICD
CM coding guidelines, ensuring accurate documentation of the causative agent and any complications
Include any relevant history of exposure and vaccination status

Exclusion Criteria

Do NOT use A43.0 When

No specific exclusions found.

Related CPT Codes

87070CPT Code

Culture, bacterial, any source

Clinical Scenario

Used when laboratory confirmation of Bordetella pertussis is required.

Documentation Requirements

Document the reason for the culture and any relevant clinical findings.

Specialty Considerations

Infectious disease specialists may require additional documentation regarding the patient's immune status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of whooping cough, improving the ability to track outbreaks and manage public health responses effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of whooping cough, improving the ability to track outbreaks and manage public health responses effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of whooping cough, improving the ability to track outbreaks and manage public health responses effectively.

Resources

Clinical References

•
CDC Pertussis Information

Coding & Billing References

•
CDC Pertussis Information

Frequently Asked Questions

What is the primary cause of whooping cough?

Whooping cough is primarily caused by the bacterium Bordetella pertussis, which is highly contagious and can lead to severe respiratory illness.

ICD-10 A43.0 is a billable code used to indicate a diagnosis of whooping cough due to bordetella pertussis.