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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.4

O26.4

Billable

Herpes gestationis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O26.4 is a billable code used to indicate a diagnosis of herpes gestationis.

Key Diagnostic Point:

Herpes gestationis, also known as pemphigoid gestationis, is a rare autoimmune blistering disorder that occurs during pregnancy. It typically presents in the second or third trimester and is characterized by the sudden onset of pruritic, urticarial lesions that can progress to vesicles and bullae. The lesions often begin on the abdomen and can spread to other areas, including the extremities. The condition is associated with a maternal immune response to placental antigens, leading to the production of autoantibodies that target the basement membrane of the skin. Although herpes gestationis is not directly harmful to the fetus, it can lead to complications such as preterm birth or low birth weight due to maternal discomfort and stress. Management typically involves the use of topical corticosteroids and, in more severe cases, systemic corticosteroids. Close monitoring of the mother and fetus is essential to ensure optimal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other dermatological conditions in pregnancy.
  • Potential overlap with other autoimmune disorders.
  • Need for thorough documentation of symptoms and treatment.
  • Monitoring for complications that may affect maternal and fetal health.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the trimester of onset.
  • Misclassification with other skin conditions.
  • Lack of follow-up documentation regarding treatment response.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of the onset, location, and characteristics of lesions, as well as treatment plans and maternal-fetal monitoring.

Common Clinical Scenarios

A pregnant patient presents with itchy, blistering lesions on the abdomen; management includes topical steroids and monitoring for fetal well-being.

Billing Considerations

Consideration of maternal comfort and potential impacts on delivery plans.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal health status, fetal monitoring results, and any interventions required.

Common Clinical Scenarios

A high-risk pregnancy where the mother has a history of autoimmune disorders and presents with new-onset skin lesions.

Billing Considerations

Close monitoring for potential complications such as preterm labor or fetal distress.

Coding Guidelines

Inclusion Criteria

Use O26.4 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring accurate documentation of the condition's onset and management
  • Specific criteria for coding should include the trimester of pregnancy and any associated complications

Exclusion Criteria

Do NOT use O26.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, level 3

Clinical Scenario

Used during follow-up visits for management of herpes gestationis.

Documentation Requirements

Document the patient's symptoms, treatment response, and any changes in condition.

Specialty Considerations

Obstetricians should ensure that all relevant details are captured to support the visit.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

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

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What are the common treatments for herpes gestationis?

Common treatments include topical corticosteroids for mild cases and systemic corticosteroids for more severe cases. Close monitoring of both maternal and fetal health is essential.