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ICD-10 Guide
ICD-10 CodesA60.1

A60.1

Herpesviral infection of genitalia and urogenital tract, unspecified

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

Code Description

ICD-10 A60.1 is a billable code used to indicate a diagnosis of herpesviral infection of genitalia and urogenital tract, unspecified.

Key Diagnostic Point:

Herpesviral infections of the genitalia and urogenital tract are primarily caused by the herpes simplex virus (HSV), which can manifest as genital herpes. This condition is characterized by painful blisters or sores in the genital area, which can recur periodically. The infection can be asymptomatic, leading to undiagnosed cases that may still be transmissible. The unspecified nature of this code indicates that the specific type of herpesvirus (HSV-1 or HSV-2) is not documented, which can complicate treatment and management. Diagnosis typically involves clinical evaluation and may be confirmed through laboratory testing, including viral cultures or polymerase chain reaction (PCR) tests. Screening protocols often recommend testing for sexually active individuals with symptoms or known exposure, as well as pregnant women to prevent neonatal herpes. Management includes antiviral medications to reduce symptoms and transmission risk. Education on safe sexual practices is also crucial in managing this infection.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the code can lead to ambiguity in documentation.
  • Differentiating between HSV-1 and HSV-2 may require additional testing.
  • Potential for co-infection with other sexually transmitted infections (STIs).
  • Variability in clinical presentation can complicate diagnosis.

Audit Risk Factors

  • Inadequate documentation of symptoms or clinical findings.
  • Failure to specify the type of herpesvirus involved.
  • Lack of supporting lab results for diagnosis.
  • Inconsistent coding practices across providers.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, including sexual history and previous infections.

Common Clinical Scenarios

Patients presenting with recurrent genital lesions or atypical symptoms.

Billing Considerations

Consideration of co-infections and comprehensive STI screening.

Obstetrics and Gynecology

Documentation Requirements

Documentation of pregnancy status and potential risks to the fetus.

Common Clinical Scenarios

Pregnant women with a history of genital herpes or presenting with symptoms.

Billing Considerations

Importance of counseling regarding delivery methods to prevent neonatal herpes.

Coding Guidelines

Inclusion Criteria

Use A60.1 When
  • According to ICD
  • 10 guidelines, A60
  • 1 should be used when the specific type of herpesvirus is not documented
  • Coders should ensure that the documentation supports the diagnosis and that any relevant lab results are included
  • 1 or HSV

Exclusion Criteria

Do NOT use A60.1 When
  • Exclusion criteria include cases where the infection is clearly identified as HSV

Related CPT Codes

87522CPT Code

Infectious agent detection by nucleic acid (DNA or RNA); herpes simplex virus, type 1 or 2

Clinical Scenario

Used when laboratory testing is performed to confirm herpes infection.

Documentation Requirements

Lab results must be included in the patient's medical record.

Specialty Considerations

Infectious disease specialists may require more detailed documentation of the patient's history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of herpesviral infections, improving the accuracy of diagnosis and treatment tracking. A60.1 provides a clear framework for coding unspecified cases, but it also emphasizes the need for thorough documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of herpesviral infections, improving the accuracy of diagnosis and treatment tracking. A60.1 provides a clear framework for coding unspecified cases, but it also emphasizes the need for thorough documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of herpesviral infections, improving the accuracy of diagnosis and treatment tracking. A60.1 provides a clear framework for coding unspecified cases, but it also emphasizes the need for thorough documentation.

Resources

Clinical References

  • •
    CDC: Genital Herpes - CDC

Coding & Billing References

  • •
    CDC: Genital Herpes - CDC

Frequently Asked Questions

What should I document to support the use of A60.1?

Document the patient's symptoms, any relevant sexual history, and lab results confirming the herpes infection. Ensure that the documentation clearly indicates that the specific type of herpesvirus is unspecified.