Monkeypox ICD-10-CM Coding

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With the increased number of Monkeypox in our communities, it’s important to understand the virus clinically and the ICD-10-CM coding of this disease. Monkeypox cases in the United States as of 9/30/2022 were 26,049 cases and two deaths according to the CDC.

Over this past summer (July), the Director General of the World Health Organization, “WHO,” declared the outbreak of monkeypox to be a public health emergency of international concern and issued Temporary Recommendations to help countries fight the outbreak and bring it under control.

Monkeypox is a virus and has symptoms that usually start within 3 weeks following exposure to the virus. Individuals may start by having flu-like symptoms, and will usually develop a rash 1-4 days later, but there are reports of individuals getting the rash first. The rash and/or lesions (as they are also referred to) typically last 2-4 weeks according to the Centers for Disease Control and Prevention (CDC). The lesions are small, raised, and usually white, pink, or flesh-colored. They are firm or rubbery, well-circumscribed, deep-seated, and often develop umbilication (resembling a dot or pit on the top of the lesion) at the center. Monkeypox is spread through close or intimate contact. The following is from the CDC site:

  • Monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including:
    • Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox.
    • Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
    • Contact with respiratory secretions.
  • This direct contact can happen during intimate contact, including:
    • Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus (butthole) of a person with monkeypox.
    • Hugging, massage, and kissing.
    • Prolonged face-to-face contact.
    • Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.
    • A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed.

Currently, the CDC states that testing is only recommended if you have a rash consistent with Monkeypox or are at healthcare risk. The testing does require a provider to use a swab, to rub vigorously across lesions of the rash. The provider will take swabs from more than one lesion and the swabbing may be uncomfortable but is necessary to get enough material to detect the monkeypox virus from the specimens. The results usually take a few days to get back. Check with your healthcare provider if there are any questions about the Monkeypox virus or testing. Of course, there is continuing research being conducted, so the collection of data is vital. The CDC has good information to read over at:

In the ICD-10-CM coding classification, the alphabetic index has “Monkeypox” listed with a direction to see the tabular code B04. There is no other instruction in the alphabetic index. Then, see the tabular list for Chapter 1 Infectious and Parasitic Diseases, and under the B00—B09 Viral infections characterized by skin and mucous membrane lesions. Then go to the B04 Monkeypox code, which has no instructional notes associated with it, so this is the code to assign.

The American Hospital Association (AHA) Coding Clinic on ICD-10-CM/PCS published guidance in their third quarter issue of 2022 that provides some additional insight into scenarios related to Monkeypox. If a patient comes for medical care due to “exposure” to Monkeypox and that is the reason for the encounter/visit, then you will assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. Another scenario coding professionals might see is an encounter/visit for follow-up after the individual no longer has Monkeypox (no longer has the virus). For this encounter, you will assign two ICD-10-CM codes. The ICD-10-CM code Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm as the first-listed code and to capture the personal history of having Monkeypox, and you will assign ICD-10-CM code Z86.19, Personal history of other infectious and parasitic diseases as the secondary diagnosis code.

As always, review the clinical documentation for each encounter carefully for complete, accurate and compliant code assignments.


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