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v1.0.0
ICD-10 Guide
ICD-10 CodesA92.5

A92.5

West Nile virus infection.

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

Code Description

ICD-10 A92.5 is a billable code used to indicate a diagnosis of west nile virus infection..

Key Diagnostic Point:

West Nile virus infection is an arthropod-borne viral infection primarily transmitted to humans through the bite of infected mosquitoes. The virus is part of the Flavivirus genus and is endemic in many regions, particularly in Africa, Europe, the Middle East, North America, and West Asia. Clinically, the infection can range from asymptomatic to severe neurological disease. Symptoms typically appear 3 to 14 days after exposure and may include fever, headache, body aches, joint pains, vomiting, diarrhea, and rash. In severe cases, the infection can lead to neuroinvasive diseases such as meningitis or encephalitis, characterized by high fever, confusion, seizures, and paralysis. Diagnosis is primarily based on clinical presentation and serological testing for West Nile virus-specific IgM antibodies in serum or cerebrospinal fluid. Travel history is crucial, as individuals returning from endemic areas may present with symptoms. Given the potential for severe outcomes, particularly in older adults and immunocompromised individuals, timely diagnosis and management are essential.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate travel history documentation.
  • Differentiation from other arboviral infections.
  • Potential for severe complications requiring detailed clinical notes.
  • Variability in symptom presentation among different populations.

Audit Risk Factors

  • Inadequate documentation of travel history.
  • Failure to document neurological symptoms in severe cases.
  • Misclassification of the infection as a non-neuroinvasive form.
  • Lack of serological test results in the medical record.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes including travel history, symptom onset, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever and neurological symptoms after travel to endemic areas.

Billing Considerations

Consideration of co-infections with other arboviruses and the need for differential diagnosis.

Neurology

Documentation Requirements

Comprehensive neurological examination findings and imaging results.

Common Clinical Scenarios

Patients with encephalitis or meningitis symptoms linked to West Nile virus.

Billing Considerations

Documentation of neurological deficits and their progression is critical for accurate coding.

Coding Guidelines

Inclusion Criteria

Use A92.5 When
  • According to the ICD
  • CM coding guidelines, A92
  • 5 should be used when a patient is diagnosed with West Nile virus infection
  • It is important to document the clinical presentation, travel history, and any laboratory confirmation

Exclusion Criteria

Do NOT use A92.5 When
  • Exclusions include other viral infections that may present similarly

Related CPT Codes

86788CPT Code

West Nile virus antibody test

Clinical Scenario

When a patient presents with symptoms suggestive of West Nile virus infection.

Documentation Requirements

Document the clinical rationale for testing and any relevant travel history.

Specialty Considerations

Infectious disease specialists should ensure comprehensive documentation of symptoms and exposure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of West Nile virus infection, improving data accuracy and enhancing the ability to track outbreaks and manage public health responses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of West Nile virus infection, improving data accuracy and enhancing the ability to track outbreaks and manage public health responses.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    CDC West Nile Virus Overview

Coding & Billing References

  • •
    CDC West Nile Virus Overview

Frequently Asked Questions

What are the common symptoms of West Nile virus infection?

Common symptoms include fever, headache, body aches, joint pains, vomiting, diarrhea, and rash. Severe cases may lead to neurological symptoms such as confusion, seizures, and paralysis.

How is West Nile virus diagnosed?

Diagnosis is primarily based on clinical presentation and serological testing for West Nile virus-specific IgM antibodies in serum or cerebrospinal fluid.