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v1.0.0
ICD-10 Guide
ICD-10 CodesB26.9

B26.9

Mumps, unspecified

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

Code Description

ICD-10 B26.9 is a billable code used to indicate a diagnosis of mumps, unspecified.

Key Diagnostic Point:

Mumps is a viral infection caused by the mumps virus, which is a member of the Paramyxoviridae family. It primarily affects the salivary glands, particularly the parotid glands, leading to swelling and pain. The condition is characterized by fever, headache, muscle aches, fatigue, and loss of appetite, followed by the hallmark symptom of parotitis, which is the swelling of the parotid glands. Mumps is transmitted through respiratory droplets or direct contact with an infected person's saliva. While mumps was once a common childhood illness, the widespread use of the measles, mumps, and rubella (MMR) vaccine has significantly reduced its incidence. However, outbreaks can still occur, particularly in communities with low vaccination rates. Diagnosis is typically made based on clinical presentation and confirmed through serological testing for mumps-specific IgM antibodies or PCR testing of saliva or urine. Treatment is primarily supportive, focusing on symptom relief, as there are no specific antiviral treatments for mumps. Complications can include orchitis, oophoritis, meningitis, and encephalitis, which may require additional medical attention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptomatology
  • Need for laboratory confirmation in atypical cases
  • Differentiation from other viral infections with similar symptoms
  • Documentation of vaccination status and history

Audit Risk Factors

  • Inadequate documentation of clinical symptoms
  • Failure to document vaccination history
  • Misdiagnosis due to similar viral infections
  • Lack of laboratory confirmation in cases of atypical presentation

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of vaccination status, clinical symptoms, and any complications.

Common Clinical Scenarios

Children presenting with fever and parotid swelling, particularly in unvaccinated populations.

Billing Considerations

Ensure accurate documentation of vaccination history and any potential exposure to mumps.

Infectious Disease

Documentation Requirements

Comprehensive lab results, including serology and PCR tests, and detailed clinical notes.

Common Clinical Scenarios

Adults with suspected mumps presenting with orchitis or meningitis.

Billing Considerations

Focus on differential diagnosis and potential complications that may require additional coding.

Coding Guidelines

Inclusion Criteria

Use B26.9 When
  • According to ICD
  • 10 guidelines, B26
  • 9 is used when mumps is diagnosed without specifying complications
  • Coders should ensure that the diagnosis is supported by clinical findings and, if applicable, laboratory results

Exclusion Criteria

Do NOT use B26.9 When
  • Exclusion criteria include cases where mumps is confirmed with complications

Related CPT Codes

86765CPT Code

Mumps antibody test

Clinical Scenario

When serological testing is performed to confirm mumps infection.

Documentation Requirements

Document the reason for the test and the clinical findings leading to testing.

Specialty Considerations

Pediatricians should ensure vaccination history is included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of mumps and its complications, improving the accuracy of health records and facilitating better tracking of outbreaks and vaccination coverage.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of mumps and its complications, improving the accuracy of health records and facilitating better tracking of outbreaks and vaccination coverage.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of mumps and its complications, improving the accuracy of health records and facilitating better tracking of outbreaks and vaccination coverage.

Resources

Clinical References

  • •
    CDC Mumps Information

Coding & Billing References

  • •
    CDC Mumps Information

Frequently Asked Questions

What are the common symptoms of mumps?

Common symptoms include fever, headache, muscle aches, fatigue, loss of appetite, and swelling of the parotid glands.

How is mumps diagnosed?

Mumps is diagnosed based on clinical symptoms and can be confirmed with serological testing for mumps-specific IgM antibodies or PCR testing.

What is the treatment for mumps?

There is no specific antiviral treatment for mumps; management is supportive, focusing on symptom relief.