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ICD-10 Guide
ICD-10 CodesA92.31

A92.31

West Nile virus infection with encephalitis

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

Code Description

ICD-10 A92.31 is a billable code used to indicate a diagnosis of west nile virus infection with encephalitis.

Key Diagnostic Point:

West Nile virus (WNV) infection with encephalitis is a serious neurological condition caused by the West Nile virus, which is primarily transmitted to humans through the bite of infected mosquitoes. The virus can lead to a range of symptoms, from mild flu-like signs to severe neurological complications, including encephalitis, which is characterized by inflammation of the brain. Patients may present with fever, headache, neck stiffness, altered mental status, and neurological deficits. Diagnosis is typically confirmed through serological testing for WNV-specific IgM antibodies in serum or cerebrospinal fluid (CSF). Encephalitis can result in long-term neurological sequelae, making early recognition and management critical. The condition is more prevalent in certain geographic areas, particularly during warmer months when mosquito populations are high. Travel history to endemic regions is essential for diagnosis, as it can help identify potential exposure to the virus. Given the potential for severe outcomes, including mortality, timely intervention and supportive care are vital for affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate travel history documentation
  • Differentiation from other viral encephalitides
  • Requirement for serological confirmation
  • Potential for co-infection with other arboviruses

Audit Risk Factors

  • Inadequate documentation of travel history
  • Failure to document neurological examination findings
  • Lack of serological test results in the medical record
  • Misclassification of symptoms as non-specific viral illness

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed travel history, clinical symptoms, laboratory test results, and neurological assessments.

Common Clinical Scenarios

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

Billing Considerations

Ensure all relevant laboratory results are included in the documentation to support the diagnosis.

Neurology

Documentation Requirements

Comprehensive neurological examination findings, imaging studies, and CSF analysis.

Common Clinical Scenarios

Patients with acute onset of neurological deficits and confirmed WNV infection.

Billing Considerations

Document the extent of neurological impairment and any long-term sequelae.

Coding Guidelines

Inclusion Criteria

Use A92.31 When
  • According to the ICD
  • CM coding guidelines, A92
  • 31 should be used when there is a confirmed diagnosis of West Nile virus infection with encephalitis
  • Documentation must support the diagnosis, including clinical symptoms, travel history, and laboratory findings

Exclusion Criteria

Do NOT use A92.31 When
  • Exclusion criteria include other viral infections that may present similarly

Related CPT Codes

86788CPT Code

West Nile virus antibody test

Clinical Scenario

Used to confirm diagnosis in patients with suspected WNV infection.

Documentation Requirements

Document the reason for testing and any relevant clinical findings.

Specialty Considerations

Infectious disease specialists should ensure comprehensive testing is performed.

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 infections, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in tracking epidemiological trends and resource allocation for public health responses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of West Nile virus infections, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in tracking epidemiological trends and resource allocation for public health responses.

Reimbursement & Billing Impact

reimbursement processes. The detailed coding structure helps in tracking epidemiological trends and resource allocation for public health responses.

Resources

Clinical References

  • •
    CDC West Nile Virus Information

Coding & Billing References

  • •
    CDC West Nile Virus Information

Frequently Asked Questions

What are the common symptoms of West Nile virus infection with encephalitis?

Common symptoms include fever, headache, neck stiffness, confusion, seizures, and other neurological deficits. Severe cases may lead to coma or death.