May 10, 2010

Coding for Shingles
For The Record
Vol. 22 No. 9 P. 27

Shingles is a viral infection of the nerve roots that causes a painful rash. Although shingles can occur anywhere on the body, it most commonly appears around the middle of the torso from the middle of the back to the breastbone and usually affects only one side of the body. It may also appear on the belly, head, face, neck, or one arm or leg. The rash appears as a band or strip of blisters.

Also commonly documented as herpes zoster, shingles is caused by the varicella-zoster virus. It is not the same virus responsible for cold sores or genital herpes. However, it is the same virus that causes chicken pox. After a patient has chicken pox, the virus lies dormant in the nerve roots near the brain and spinal cord. The virus may reactivate years later as shingles, not as chicken pox. Shingles is more common in older adults and those with a weakened immune system. Anyone who has had chicken pox can get shingles. Shingles is not contagious, but a person with shingles can spread chicken pox to anyone who has not had it.

Shingles is classified to ICD-9-CM category 053. The fourth and/or fifth digit identifies the location and some complications associated with herpes zoster. The most common complications from shingles may include cellulitis or a bacterial skin infection, postherpetic neuralgia (pain that persists longer than a month even after rash is gone), vision loss, encephalitis, hearing problems, and facial paralysis.

Category 053 includes the following conditions:

• 053.0, Herpes zoster with meningitis;

• 053.10, Herpes zoster with unspecified nervous system complication;

• 053.11, Geniculate herpes zoster, which also includes herpetic geniculate ganglionitis and Ramsay-Hunt syndrome;

• 053.12, Postherpetic trigeminal neuralgia, which also includes postherpetic trifacial neuralgia

• 053.13, Postherpetic polyneuropathy;

• 053.19, Herpes zoster with nervous system complication, which includes postherpetic neuralgia and herpes zoster with encephalitis;

• 053.20, Herpes zoster dermatitis of eyelid;

• 053.21, Herpes zoster keratoconjunctivitis;

• 053.22, Herpes zoster iridocyclitis;

• 053.29, Herpes zoster with ophthalmic complications;

• 053.71, Otitis externa due to herpes zoster;

• 053.79, Herpes zoster with other specified complication;

• 053.8, Herpes zoster with unspecified complication; and

• 053.9, Herpes zoster without mention of complication.

Symptoms
Pain is usually the first symptom of shingles and may be intense, continuing even after the rash disappears. However, no rash may develop. The condition’s duration is typically three to four weeks from beginning to end and it may appear in stages. The first stage may include headache, light sensitivity, and flulike symptoms without a fever. The second stage of symptoms may include itching, tingling, and pain in a certain area. These symptoms may be present a week before the rash appears.

The third stage of symptoms may include a band, a strip, or a small area of rash appearing where the second stage of symptoms were located. The rash turns into a cluster of blisters, which fill with fluid and then crust over.

Treatment
The following medications may be prescribed to treat shingles:

• Antiviral medications that are started within 72 hours of first sign of shingles, such as acyclovir, valacyclovir, or famciclovir.

• Pain medications such as narcotics, tricyclic antidepressants (amitriptyline), anticonvulsants (gabapentin, pregabalin, or carbamazepine), or a numbing agent (lidocaine).

• Over-the-counter pain medications such as acetaminophen, aspirin, or ibuprofen.

There is a shingles vaccination called Zostavax available for people over the age of 60 who have had chicken pox. However, it can’t be used to treat people who currently have the disease. Also, Varivax is a varicella vaccine that prevents chicken pox, reducing the chances of complications and the severity of the disease.

Coding and sequencing for shingles are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.