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v1.0.0
ICD-10 Guide
ICD-10 CodesB26.3

B26.3

Erysipelas caused by Streptococcus pyogenes

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

Code Description

ICD-10 B26.3 is a billable code used to indicate a diagnosis of erysipelas caused by streptococcus pyogenes.

Key Diagnostic Point:

Erysipelas is a bacterial skin infection characterized by a well-defined, raised, red area of skin that is often warm and painful. It is primarily caused by Streptococcus pyogenes, a group A streptococcus. The infection typically occurs on the face or legs and can be associated with fever, chills, and malaise. The skin lesions are often preceded by trauma or breaks in the skin, allowing the bacteria to enter. Diagnosis is primarily clinical, based on the appearance of the skin and associated symptoms. Laboratory tests may include blood cultures or swabs from the affected area, although these are not always necessary. Treatment usually involves antibiotics, with penicillin being the first-line therapy. In severe cases, hospitalization may be required for intravenous antibiotics and supportive care. Complications can include abscess formation, cellulitis, or systemic infection, particularly in immunocompromised patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating erysipelas from other skin infections like cellulitis.
  • Understanding the specific causative organism (Streptococcus pyogenes).
  • Documenting the clinical presentation accurately.
  • Recognizing the need for potential laboratory tests.

Audit Risk Factors

  • Inadequate documentation of the clinical presentation.
  • Failure to specify the causative organism.
  • Misclassification of the condition as cellulitis.
  • Lack of supporting lab results when applicable.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on the infection's progression and treatment response.

Common Clinical Scenarios

Patients presenting with fever and localized skin redness.

Billing Considerations

Ensure that the causative organism is documented and that any antibiotic resistance is noted.

Dermatology

Documentation Requirements

Photographic evidence of skin lesions and detailed descriptions of the rash.

Common Clinical Scenarios

Patients with recurrent skin infections or those with underlying skin conditions.

Billing Considerations

Document any prior treatments and responses to ensure accurate coding.

Coding Guidelines

Inclusion Criteria

Use B26.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant lab results and specify the causative organism when applicable

Exclusion Criteria

Do NOT use B26.3 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when a patient with erysipelas is seen for follow-up.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Ensure that the visit is clearly linked to the erysipelas diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of erysipelas, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    CDC Erysipelas Information

Coding & Billing References

  • •
    CDC Erysipelas Information

Frequently Asked Questions

What is the primary cause of erysipelas?

Erysipelas is primarily caused by Streptococcus pyogenes, a type of bacteria that can enter the skin through cuts or abrasions.