ICD-10-CM 2017 Simplifies Your Zika Virus Reporting

Posted on 2 Jan, 2017 |comments_icon 0|By Chris Boucher

ICD-10-CM 2017 Simplifies Your Zika Virus Reporting

To justify Zika testing, report the symptoms

At this time of year, you should be feeling at ease with the ICD-10-CM changes that went into effective Oct. 1, 2016. However when emerging infectious diseases, such as the Zika virus surface, selecting the most precise ICD-10 code can be challenging for coders and clinicians alike.

Good News: Zika Virus Has its Own Code Now

The 2017 ICD-10-CM simplifies your task by introducing a specific code for Zika virus — A92.5 (Zika virus disease) — that you can use to represent the condition when your provider has confirmed the case. Before this code made its appearance, there were no ICD-10 codes for Zika — you would likely have chosen A92.8 (Other specified mosquito-borne viral fevers) for a positive diagnosis.


Why the change: A92.8 did not quite fit the Zika virus. So the CDC added the more specific code A92.5 in the 2017 update. Now you need not worry about nebulous diagnosis coding for your Zika patients.

What’s this: Even though the Zika virus spreads mainly through infected Aedes species mosquitoes, it also spreads by other transmission modes, including blood transfusions and from the mother to child. That’s the reason varied conditions might indicate the need for a Zika test —from travel to symptoms such as fever and join pain to possible virus exposure through other means.

Look up your ICD-10 coding books: In the index of the ICD-10 book, under “Z” there’s a main term Zika virus with code A92.5. Likewise, if you look up the letter ‘D’ and select the main term ‘Disease’, you’ll find a sub-term Zika virus. Again, under the main term ‘Fever’, you’ll spot a sub-term Zika virus. All of these take you to your new specific Zika virus code. So when the documentation shows a positive Zika virus NOS case or Zika virus fever, you can report Z92.5.

How to Report Zika Testing

If your physician suspects Zika related disease and asks the patient to go for a test, you’ll have to report the diagnosis based on the symptoms that the patient is suffering.  Do not use the new Zika virus code here — instead you’ll have to support the medical necessity of the testing by reporting these the symptoms.

Heed this: You cannot report the patient as having Zika until and unless the case has been confirmed.

Background: Since WHO declared Zika as a public health emergency in Feb. 2016, CMS declared that it will provide coverage under Medicare Part B when patients undergo tests through diagnostic lab tests.

If you’re looking for further insight on Zika virus coverage and reporting, these articles can be really helpful:

Zika Update: Stay Abreast of Coverage, Diagnosis, and Blood Bank Changes

Zika Update: Breaking News: Testing for Zika Virus is Now Covered Under Part B


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

More from this author

View More

Newsletter Signup