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v1.0.0
ICD-10 Guide
ICD-10 CodesA69.0

A69.0

Lyme disease

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

Code Description

ICD-10 A69.0 is a billable code used to indicate a diagnosis of lyme disease.

Key Diagnostic Point:

Lyme disease is an infectious disease caused by the spirochete Borrelia burgdorferi, which is transmitted to humans through the bite of infected Ixodes ticks, commonly known as deer ticks. The disease is characterized by a range of symptoms, including erythema migrans (a distinctive rash), fever, headache, fatigue, and muscle and joint aches. If left untreated, Lyme disease can lead to more severe complications, such as neurological disorders, arthritis, and cardiac issues. The geographic distribution of Lyme disease is primarily in the northeastern, north-central, and Pacific coastal regions of the United States, with endemic areas including parts of Connecticut, New York, New Jersey, Wisconsin, and California. The incidence of Lyme disease has been increasing, particularly in suburban areas where human-tick interactions are more common. Diagnosis is often based on clinical presentation and history of tick exposure, supplemented by serological testing for antibodies against Borrelia. Early detection and treatment with antibiotics are crucial for effective management of the disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied clinical presentations can complicate diagnosis.
  • Differentiation from other tick-borne diseases is necessary.
  • Geographic variations in prevalence may affect coding.
  • Documentation of tick exposure is critical for accurate coding.

Audit Risk Factors

  • Inadequate documentation of tick exposure.
  • Failure to document the characteristic erythema migrans rash.
  • Misdiagnosis due to overlapping symptoms with other diseases.
  • Lack of follow-up documentation for treatment efficacy.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history including travel and exposure history, clinical findings, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever, rash, and joint pain after potential tick exposure.

Billing Considerations

Consideration of co-infections and the need for serological testing.

Primary Care

Documentation Requirements

Thorough documentation of symptoms, exposure history, and treatment plans.

Common Clinical Scenarios

Patients with early signs of Lyme disease or those presenting with flu-like symptoms.

Billing Considerations

Importance of patient education regarding tick prevention and recognition of symptoms.

Coding Guidelines

Inclusion Criteria

Use A69.0 When
  • According to the official coding guidelines, Lyme disease is classified under A69
  • Coders should ensure that documentation supports the diagnosis, including evidence of tick exposure and clinical symptoms
  • borne diseases that may present similarly

Exclusion Criteria

Do NOT use A69.0 When
  • Exclusion criteria include other tick

Related CPT Codes

87491CPT Code

Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi

Clinical Scenario

Used when testing for Lyme disease in symptomatic patients.

Documentation Requirements

Document the reason for testing and clinical symptoms.

Specialty Considerations

Infectious disease specialists may require additional lab results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of Lyme disease, improving the accuracy of data collection and epidemiological tracking. This specificity aids in better understanding the disease's prevalence and management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of Lyme disease, improving the accuracy of data collection and epidemiological tracking. This specificity aids in better understanding the disease's prevalence and management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of Lyme disease, improving the accuracy of data collection and epidemiological tracking. This specificity aids in better understanding the disease's prevalence and management.

Resources

Clinical References

  • •
    Centers for Disease Control and Prevention (CDC) - Lyme Disease

Coding & Billing References

  • •
    Centers for Disease Control and Prevention (CDC) - Lyme Disease

Frequently Asked Questions

What are the common symptoms of Lyme disease?

Common symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If untreated, it can lead to more severe symptoms affecting the joints, heart, and nervous system.