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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.41

O26.41

Billable

Herpes gestationis, first trimester

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

Code Description

ICD-10 O26.41 is a billable code used to indicate a diagnosis of herpes gestationis, first trimester.

Key Diagnostic Point:

Herpes gestationis, also known as pemphigoid gestationis, is an autoimmune blistering disorder that typically arises during pregnancy, often in the first trimester. It is characterized by the development of 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 antigens. While it is not directly harmful to the fetus, it can lead to complications such as preterm birth or low birth weight if not managed properly. Maternal care involves monitoring for skin lesions, managing itching, and ensuring that the mother is comfortable. Treatment may include topical corticosteroids or antihistamines. It is crucial for healthcare providers to differentiate herpes gestationis from other conditions such as herpes simplex virus infections or other dermatoses of pregnancy to ensure appropriate management and care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other skin conditions in pregnancy
  • Potential for misdiagnosis with herpes simplex
  • Need for thorough documentation of symptoms and treatment
  • Management of associated maternal discomfort

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the trimester of pregnancy
  • Misclassification of the condition as herpes simplex
  • Lack of follow-up documentation on treatment efficacy

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 patient responses.

Common Clinical Scenarios

A pregnant patient presents with itchy blisters on the abdomen; differential diagnosis includes herpes gestationis versus herpes simplex.

Billing Considerations

Ensure that the diagnosis is clearly documented to avoid confusion with other conditions, and monitor for any complications that may arise.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal and fetal health, including any potential impacts of herpes gestationis on pregnancy outcomes.

Common Clinical Scenarios

Management of a high-risk pregnancy where the mother has a history of autoimmune conditions, including herpes gestationis.

Billing Considerations

Close monitoring of fetal growth and development, as well as maternal comfort and health.

Coding Guidelines

Inclusion Criteria

Use O26.41 When
  • Follow the official ICD
  • CM guidelines for coding obstetric conditions, ensuring that the trimester is accurately documented and that the condition is clearly differentiated from other similar diagnoses

Exclusion Criteria

Do NOT use O26.41 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 to manage symptoms of herpes gestationis.

Documentation Requirements

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

Specialty Considerations

Obstetricians should ensure that the visit is clearly related to the management of the pregnancy.

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 during pregnancy includes the use of topical corticosteroids to manage itching and blistering. In severe cases, systemic corticosteroids may be considered. It is essential to monitor the condition closely to prevent complications.