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ICD-10 Guide
ICD-10 CodesO26.40

O26.40

Billable

Herpes gestationis, unspecified trimester

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

Code Description

ICD-10 O26.40 is a billable code used to indicate a diagnosis of herpes gestationis, unspecified trimester.

Key Diagnostic Point:

Herpes gestationis, also known as pemphigoid gestationis, is an autoimmune blistering skin condition that occurs during pregnancy. It typically presents with itchy, blistering lesions that can appear on the abdomen, arms, and legs. The condition is thought to be related to the body's immune response to placental proteins. While it can occur at any time during pregnancy, it is most commonly seen in the second trimester. The lesions may cause significant discomfort and can lead to complications such as secondary infections. Management often involves the use of topical corticosteroids and antihistamines to alleviate symptoms. In severe cases, systemic corticosteroids may be required. It is crucial for healthcare providers to monitor the condition closely, as it can sometimes recur in subsequent pregnancies or during the postpartum period. The diagnosis is primarily clinical, supported by histological findings, and it is essential to differentiate herpes gestationis from other conditions such as herpes simplex virus infections, which require different management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other dermatological conditions
  • Management of associated symptoms and complications
  • Potential for recurrence in future pregnancies
  • Need for coordination with dermatology specialists

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the trimester of occurrence
  • Misdiagnosis leading to incorrect coding
  • Lack of follow-up documentation for management

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of the patient's symptoms, treatment plan, and response to therapy is essential. Include the onset of symptoms and any relevant obstetric history.

Common Clinical Scenarios

A pregnant patient presents with severe itching and blistering on the abdomen, requiring evaluation and management.

Billing Considerations

Consider the impact of the condition on the patient's quality of life and potential complications for both mother and fetus.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal and fetal health, including any high-risk factors associated with herpes gestationis.

Common Clinical Scenarios

Management of a patient with a history of herpes gestationis in previous pregnancies, requiring close monitoring.

Billing Considerations

Evaluate the need for multidisciplinary care, including dermatology and obstetrics, to manage the condition effectively.

Coding Guidelines

Inclusion Criteria

Use O26.40 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring accurate documentation of the trimester and any associated complications
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use O26.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

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

Documentation Requirements

Document the patient's symptoms, treatment plan, and response to therapy.

Specialty Considerations

Obstetricians should ensure coordination with dermatology for comprehensive care.

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 is the primary treatment for herpes gestationis during pregnancy?

The primary treatment for herpes gestationis includes topical corticosteroids to alleviate itching and inflammation. In severe cases, systemic corticosteroids may be necessary. It is important to monitor the condition closely to prevent complications.