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v1.0.0
ICD-10 Guide
ICD-10 CodesA60.9

A60.9

Anogenital herpesviral infection, unspecified

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

Code Description

ICD-10 A60.9 is a billable code used to indicate a diagnosis of anogenital herpesviral infection, unspecified.

Key Diagnostic Point:

Anogenital herpesviral infection, unspecified (A60.9) refers to a viral infection caused by the herpes simplex virus (HSV) that affects the anogenital region. This condition can manifest as painful blisters or sores in the genital area, rectum, or surrounding skin. The infection is primarily transmitted through sexual contact, and it can be asymptomatic in some individuals, leading to unintentional transmission. Symptoms may include itching, burning sensations, and discomfort during urination. The diagnosis is typically made based on clinical examination and patient history, although laboratory tests such as PCR or viral cultures may be utilized for confirmation. 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 strategies. Patients with anogenital herpes are at increased risk for acquiring and transmitting other sexually transmitted infections (STIs), making screening and preventive measures essential. Management often includes antiviral medications to reduce the severity and duration of outbreaks, as well as counseling on safe sexual practices.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the code may lead to ambiguity in documentation.
  • Differentiating between HSV-1 and HSV-2 can affect treatment and management.
  • Potential for co-infection with other STIs complicates coding.
  • Variability in clinical presentation may lead to misdiagnosis.

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings.
  • Failure to specify the type of herpesvirus involved.
  • Lack of supporting laboratory test results.
  • Inconsistent coding practices across providers.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, including sexual history and previous infections, must be documented. Laboratory results should be included to support the diagnosis.

Common Clinical Scenarios

Patients presenting with recurrent genital sores, atypical presentations of genital lesions, or those requiring management of chronic herpes infections.

Billing Considerations

Consideration of co-infections with other STIs and the need for comprehensive sexual health counseling.

Urology

Documentation Requirements

Documentation should include urinary symptoms, physical examination findings, and any relevant imaging or laboratory tests.

Common Clinical Scenarios

Patients with urinary symptoms associated with herpes lesions or those undergoing evaluation for recurrent urinary tract infections.

Billing Considerations

Urologists should be aware of the potential for herpes to mimic other urogenital conditions.

Coding Guidelines

Inclusion Criteria

Use A60.9 When
  • According to the ICD
  • CM coding guidelines, A60
  • 9 should be used when the specific type of herpesvirus is not documented
  • Coders should ensure that the documentation supports the diagnosis and that the unspecified code is appropriate given the clinical context

Exclusion Criteria

Do NOT use A60.9 When
No specific exclusions found.

Related CPT Codes

87522CPT Code

Herpes simplex virus (HSV) DNA, PCR

Clinical Scenario

When laboratory confirmation of herpes is needed.

Documentation Requirements

Documentation of symptoms and clinical findings leading to the test.

Specialty Considerations

Infectious disease specialists may order this test more frequently.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of herpes infections, which can improve data accuracy and patient management. However, the unspecified nature of A60.9 may lead to challenges in treatment planning and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of herpes infections, which can improve data accuracy and patient management. However, the unspecified nature of A60.9 may lead to challenges in treatment planning and billing.

Reimbursement & Billing Impact

billing.

Resources

Clinical References

  • •
    CDC - Genital Herpes

Coding & Billing References

  • •
    CDC - Genital Herpes

Frequently Asked Questions

What does A60.9 mean?

A60.9 refers to an unspecified anogenital herpesviral infection, indicating that the specific type of herpesvirus is not documented.

When should I use A60.9?

Use A60.9 when the documentation does not specify the type of herpesvirus affecting the anogenital region.