Coding Guidelines and Preparation for Zika Virus

Posted by Practice Management Institute on Nov 7, 2016 11:00:58 AM
Practice Management Institute

Zika first hit the Americas in March of 2015, from tourists who traveled to Brazil to watch the World Cup. According to the CDC, as of August 31, 2016, there have been 2,722 cases of Zika in the U.S., 35 of those cases were contracted within the country.  All 35 cases were contracted in Florida. It is predicted that Zika will spread most prevalently in locations where Brazilians often travel to and where the Aedes Mosquito that carries the Zika virus lives.

Zika virus is transmitted by the bite of an infected Aedes species of mosquito. It can also be spread sexually by both males and females, or be transmitted through a blood infusion. As of August 26, 2016, the FDA is requiring for all blood donations in the United States to be tested for Zika.

2017 ICD-10-CM Coding Guidelines for Zika virus can be found on page 26 of the Official Guidelines. The guidelines state to only code a confirmed diagnosis of Zika virus. That code is A92.5.  This code should be assigned regardless of how the virus was transmitted.  If Zika is only suspected or possible, do not use A92.5. Instead, assign a code explaining the reason for the encounter.

Zika is a single stranded RNA virus. It is a close relative to other viruses such as dengue, yellow fever, West Nile, and Japanese encephalitis. It was first discovered in 1947, in a rhesus monkey in the Zika Forest of Uganda.  The first human cases of Zika occurred in 1952.  The illness itself is usually mild and lasts 5-7 days.  Zika virus affects all age groups. Most people with Zika are asymptomatic. The incubation period for Zika is not currently known, but it’s estimated to be less than a week.

Symptoms of Zika virus are mild and usually include fever, rash, joint pain, and conjunctivitis. Some also experience muscle pain and headache. The biggest risk is to pregnant women. Zika can cause microcephaly and other severe birth defects.  Babies born with Zika virus may have brain and other fetal growth abnormalitites, blindness, hearing loss, seizures, or may not be carried to term. We do not know the long term effects of Zika virus on babies.  Women who are pregnant or who want to become pregnant should avoid all travel to countries that have the Zika virus.  Women who have Zika and wish to become pregnant should wait at least 8 weeks until after symptoms have resolved.

There is currently no vaccination or cure for the Zika virus. This is why prevention is so important. Taking precautions to avoid mosquitoes and areas where the virus is confirmed is essential.


For more information on Zika, please visit the CDC's website. More information on ICD-CM-Coding updates can be found in PMI's ICD-10-CM Coding Update 2017 course.

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