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ICD-10 Guide
ICD-10 CodesA86

A86

Unspecified viral encephalitis

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

Code Description

ICD-10 A86 is a billable code used to indicate a diagnosis of unspecified viral encephalitis.

Key Diagnostic Point:

Unspecified viral encephalitis is a neurological condition characterized by inflammation of the brain caused by viral infection. This condition can present with a variety of symptoms, including fever, headache, confusion, seizures, and altered consciousness. The etiology of viral encephalitis can be diverse, encompassing viruses such as herpes simplex virus, West Nile virus, and enteroviruses, among others. Diagnosis typically involves clinical evaluation, lumbar puncture for cerebrospinal fluid analysis, and imaging studies like MRI or CT scans to assess brain inflammation. The unspecified nature of this code indicates that the specific viral agent has not been identified, which can complicate treatment and management strategies. Patients may experience long-term neurological complications, including cognitive deficits, motor impairments, and seizures. Vaccination status is crucial, as certain viral infections can be prevented through vaccination, thereby reducing the incidence of encephalitis. Accurate coding requires thorough documentation of clinical findings, laboratory results, and any relevant vaccination history.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential viral etiologies
  • Need for comprehensive clinical documentation
  • Differentiation from other types of encephalitis
  • Potential for overlapping symptoms with other neurological conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify vaccination status
  • Misidentification of the viral agent
  • Lack of supporting diagnostic tests

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and laboratory tests.

Common Clinical Scenarios

Patients presenting with acute neurological symptoms, seizures, or altered mental status.

Billing Considerations

Ensure documentation includes vaccination history and any relevant travel history to assess for specific viral exposures.

Infectious Disease

Documentation Requirements

Comprehensive history of exposure, laboratory confirmation of viral infection, and treatment plans.

Common Clinical Scenarios

Patients with suspected viral infections presenting with neurological symptoms.

Billing Considerations

Documentation should clarify the suspected viral etiology and any differential diagnoses considered.

Coding Guidelines

Inclusion Criteria

Use A86 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the unspecified nature of the viral encephalitis is documented
  • Include any relevant clinical findings and diagnostic tests that support the diagnosis

Exclusion Criteria

Do NOT use A86 When
  • Exclude codes for other specified viral encephalitis when A86 is used

Related CPT Codes

62270CPT Code

Lumbar puncture

Clinical Scenario

Used to obtain cerebrospinal fluid for analysis in suspected cases of encephalitis.

Documentation Requirements

Document indication for lumbar puncture and results of CSF analysis.

Specialty Considerations

Neurologists should ensure that the procedure is justified based on clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of viral encephalitis, but the unspecified nature of A86 can lead to challenges in documentation and justification for claims.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of viral encephalitis, but the unspecified nature of A86 can lead to challenges in documentation and justification for claims.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of viral encephalitis, but the unspecified nature of A86 can lead to challenges in documentation and justification for claims.

Resources

Clinical References

  • •
    CDC Viral Encephalitis Information

Coding & Billing References

  • •
    CDC Viral Encephalitis Information

Frequently Asked Questions

What is the difference between A86 and A85?

A86 is used for unspecified viral encephalitis, while A85 is for other specified viral encephalitis where the specific virus is not identified.