Chapter 1:Certain infectious and parasitic diseases
BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED08/28/2025
Code Description
ICD-10 A60 is a used to indicate a diagnosis of anogenital herpesviral (herpes simplex) infection.
Key Diagnostic Point:
Anogenital herpesviral infection.
Code Complexity Analysis
Complexity Rating: Medium
Medium Complexity
ICD-10 code A60, which pertains mainly to Anogenital (venereal) herpesviral [herpes simplex] infection, is a level one complexity code. Complexity rating is ranked on a scale of one to three, with one being the simplest form of categorization. A code with a level one complexity means that it represents a non-specific, broad diagnosis that does not provide detailed information about the patient's medical condition.
Factors that contribute to this complexity include:
1. Medical specificity: The code A60 is non-specific in nature, which means that it does not provide detailed information about the patient’s condition. This lack of specificity can lead to issues with billing or statistical data collection.
2. Patient history: The medical history of the patient largely affects the complexity of this code. If the patient has a history of A60, it is necessary to assign more specific codes for better documentation.
3. chronicity: The ICD-10 A60 code also covers the situations of an initial encounter, encounter for observation, subsequent encounters, and sequela, which might add complexity due to the chronic nature of this code.
Audit risks associated with this code include:
1. Misinterpretation: Due to its non-specific nature, there is a risk for misinterpretation by both the healthcare provider and the billing department.
2. Inadequate documentation: As a non-billable/non-specific code, it may not be appropriate for reimbursement. To avoid this, healthcare providers should make sure to provide detailed documentation of the patient's condition, history, and treatment plan, to justify a more specific ICD-10 code for billing.
3. Risk of denial: Insurance providers may deny or delay payments because of the lack of specificity in the diagnosis code. This can be mitigated by using the most specific code available that accurately reflects the patient's diagnosis.
4. Compliance risk: Use of non-specific codes could potentially put healthcare providers at risk for compliance issues, especially if these codes are used repeatedly or inappropriately.
Remember, a good practice for medical coding is to always be as specific as possible. If a more specific code is available for a diagnosis, it should be used instead of the non-specific, non-billable code to eliminate potential problems with billing and audit risks.
Specialty Focus
Medical Specialties
The ICD-10 code A60 (Non-billable) deals with Anogenital (venereal) herpesviral infection. As such, it's likely to be most relevant for the following specialties:
1. Dermatology:
Documentation: This specialty often deals with skin manifestations of various diseases, including sexually transmitted diseases like herpes. They would diagnose and record the presence, progression, or treatment of anogenital herpes using the ICD-10 code A60.
Clinical Scenario: A 25-year-old patient presents with persistent itching, redness, and small fluid-filled blisters in the genital area. The dermatologist conducts a physical examination and a laboratory test, diagnosing the patient with anogenital herpes.
2. Gynecology:
Documentation: Here, this code would most often be used to record a diagnosis of anogenital herpes in female patients.
Clinical Scenario: A 40-year-old woman presents with genital sores and painful urination. She has had similar episodes in the past. The gynecologist performs an examination and a laboratory test, afterward diagnosing her with recurrent anogenital herpes.
3. Infectious Disease:
Documentation: Specialists in infectious diseases deal with a wide range of diseases caused by viral infections, including herpes. They're likely to use the ICD-10 code A60 to document cases involving anogenital herpes.
Clinical Scenario: A 30-year-old man goes to an infectious disease clinic with complaints of genital discomfort and sores. He is diagnosed with anogenital herpes after a laboratory analyses. His condition, history, and treatment plan would be documented with the help of the ICD-10 code A60.
Bear in mind, though, that the work of coding diseases doesn't stop at the hospital door. The ICD-10 codes are used for the collection of data from infectious disease surveillance, public health reporting, and clinical research as well. Therefore, public health, research and laboratory testing services frequently use this code for the documentation of anogenital herpes cases.
Coding Guidelines
Inclusion Criteria
Use A60 When
CM A60 is a non
billable code, which means that it cannot be used as a claim for an insurance reimbursement
It should be used for clinical notation or data collection purposes only, and not for billing purposes
It is only used to specify the diagnosis for non
reimbursement purposes
Inclusion criteria:
The diseases or conditions covered under ICD
CM A60 include anogenital (venereal) herpesviral [herpes simplex] infections that are sexually transmitted
Exclusion Criteria
Do NOT use A60 When
Exclusion criteria:
Related CPT Codes
The ICD-10 code A60 (Non-billable) refers to Anogenital (venereal) warts due to human papillomavirus (HPV). While this code isn't billable, there are related billable codes that might be used. Note that CPT codes represent the medical services a provider may give to a patient (such as procedures), consumed based on this diagnosis. Since A60 is non-billable, we'll consider related billable diagnoses (like A60.00 Anogenital (venereal) warts, unspecified) and paired CPT codes accordingly.
1. CPT Code 54056: Cryosurgery of the genital warts. This can be used in a case where a patient for the anogenital HPV warts needs cryotherapy, a procedure using cold treatment to remove warts.
2. CPT Code 56501: Destruction of vaginal lesions. This code can be used if a patient with HPV has developed vaginal or vulval warts that a gynecologist needs to remove.
3. CPT Code 54050: Destruction of the lesion(s) on the penis. If a male patient has HPV and penile warts have formed, this code can be used when a provider utilizes a procedure like cryotherapy or laser ablation to destruct them.
4. CPT Code 57452: Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage. This might be used in a case where a female patient with an HPV infection is showing potential cervical changes that need further examination and biopsy.
5. CPT Code 46924: Destruction of lesions, anal (e.g., Condyloma, malignant lesions), extensive. When the HPV infection has resulted in the formation of extensive anal warts, this CPT code will apply.
6. CPT Code 58301: Removal of an intrauterine device (IUD). This can be used in a situation where a female patient with HPV infection wishes to remove her IUD as part of managing her sexual health.
7. CPT Code 90649: Human Papillomavirus vaccine for Types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use. This commonly applies if a patient desires HPV vaccination to prevent potential HPV infections and related disease issues.
Remember, always consult your billing and coding experts, while these scenarios show real situations, each case is unique. Compliance with various insurance and regulatory guidelines must be ensured.
ICD-10 Impact
Diagnostic & Documentation Impact
Enhanced Specificity
ICD-10 Improvements
ICD-10, also known as the 10th Revision of the International Classification of Diseases, enables a higher level of coding that provides more specific data about a patient’s illness, such as the severity, anatomical location, and type of disease.
ICD-10 codes like A60 (Anogenital (venereal) herpesviral [herpes simplex] infection), although non-billable, are still essential for healthcare documentation and epidemiological research. These codes help in surveillance to monitor the prevalence of diseases and other health problems.
Specificity: ICD-10 brings a higher level of specificity to medical coding. For instance, under ICD-9, A60 would have been a more general code. With ICD-10, there are more specific codes under A60 that give more accurate information about the form of herpesviral infection a patient has.
ICD-9 vs ICD-10
ICD-10, also known as the 10th Revision of the International Classification of Diseases, enables a higher level of coding that provides more specific data about a patient’s illness, such as the severity, anatomical location, and type of disease. ICD-10 codes like A60 (Anogenital (venereal) herpesviral [herpes simplex] infection), although non-billable, are still essential for healthcare documentation and epidemiological research. These codes help in surveillance to monitor the prevalence of diseases and other health problems. Specificity: ICD-10 brings a higher level of specificity to medical coding. For instance, under ICD-9, A60 would have been a more general code. With ICD-10, there are more specific codes under A60 that give more accurate information about the form of herpesviral infection a patient has. Reimbursement: While A60 itself is non-billable, it has various billable sub-codes that are used for reimbursement purposes. These sub-codes help in getting more precise reimbursements as they thoroughly describe the...
Reimbursement & Billing Impact
Reimbursement: While A60 itself is non-billable, it has various billable sub-codes that are used for reimbursement purposes. These sub-codes help in getting more precise reimbursements as they thoroughly describe the exact condition of the patient. For example, a more severe condition would need more medical resources and thus would attract a higher reimbursement rate.
Resources
Clinical References
1. Centers for Disease Control (CDC): They provide a variety of instructional notes and a complete list of all ICD-10 codes including A60.
2. World Health Organization (WHO): WHO is the main governing body that decides on ICD-10 codes. They provide a full list of the codes and guidelines on how to use them.
3. American Health Information Management Association (AHIMA): AHIMA provides a variety of resources and information on using the ICD-10 codes properly.
4. American Academy of Professional Coders (AAPC): This organization provides resources for learning about the ICD-10 codes, including certification programs.
5. The Official ICD-10 website: This site provides the ICD-10 codes and further description of each of them including the A60 code.
6. Centers for Medicare & Medicaid Services (CMS): As a significant source of healthcare funding in the U.S., CMS provides comprehensive guidelines on ICD-10 coding.
7. National Center for Health Statistics (NCHS): As the official custodian of the ICD-10 in the US, NCHS provides various resources that include training modules and instructional manuals.
Coding & Billing References
1. Centers for Disease Control (CDC): They provide a variety of instructional notes and a complete list of all ICD-10 codes including A60.
2. World Health Organization (WHO): WHO is the main governing body that decides on ICD-10 codes. They provide a full list of the codes and guidelines on how to use them.
3. American Health Information Management Association (AHIMA): AHIMA provides a variety of resources and information on using the ICD-10 codes properly.
4. American Academy of Professional Coders (AAPC): This organization provides resources for learning about the ICD-10 codes, including certification programs.
5. The Official ICD-10 website: This site provides the ICD-10 codes and further description of each of them including the A60 code.
6. Centers for Medicare & Medicaid Services (CMS): As a significant source of healthcare funding in the U.S., CMS provides comprehensive guidelines on ICD-10 coding.
7. National Center for Health Statistics (NCHS): As the official custodian of the ICD-10 in the US, NCHS provides various resources that include training modules and instructional manuals.
Frequently Asked Questions
Q1: What is the ICD-10 code A60?
A1: The ICD-10 code A60 refers to Anogenital (venereal) herpesviral [herpes simplex] infection, which is further broken down into different specific codes for each type of infection.
Q2: Why is ICD-10 code A60 considered a non-billable code?
A2: ICD-10 code A60 is non-billable because it is not specific enough for billing purposes. To make a billable claim, you must choose a specific code that falls under A60 to accurately reflect the patient's health condition.
Q3: How does the documentation affect billing of the A60 ICD-10 code?
A3: Documentation is important for billing because it serves as the basis for selecting the most appropriate and specific code under A60. It is crucial to include clear descriptions and relevant clinical details in the patient's medical records to enable accurate coding.
Q4: Can you give an example of a billable A60 ICD-10 code?
A4: An example of a billable A60 ICD-10 code is A60.01, which is a specific code for Herpesviral vesicular dermatitis.
Q5: What is the importance of the ICD-10 code A60 in relation to the disease classification?
A5: The ICD-10 code A60 plays a significant role in disease classification. It allows medical professionals to precisely categorize the type and severity of anogenital herpesviral infections, which is beneficial in designing the most suitable treatment plan and managing patient's health records.
Q6: What happens if I accidentally use the non-billable A60 ICD-10 code for billing?
A6: If you mistakenly use the non-billable A60 ICD-10 code for billing, the likely scenario is that the claim will be rejected due to the lack of specificity. If denied, you would need to resubmit with a more specific, billable code from A60 subcategories.
Q7: How can I find the precise billable code within the A60 ICD-10 category?
A7: The Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptors used in the billing process are publicly available. You can look up these codes and their descriptions online or use digital coding tools to find the precise, billable A60 ICD-10 code for a specific condition. Be sure to also refer to the clinical documentation for accurate details.
