Herpesviral gingivostomatitis and pharyngotonsillitis

This code identifies an acute infection caused by the herpes simplex virus (HSV) that primarily affects the oral mucosa, gums, and throat. It manifests as painful vesicles and ulcers in the mouth and pharynx, often accompanied by fever and malaise. This condition is distinct from other forms of herpetic infections.

Assign this code when documentation clearly indicates a diagnosis of herpesviral gingivostomatitis and pharyngotonsillitis. This typically applies to initial or recurrent episodes where the specific viral etiology is confirmed or strongly suspected based on clinical presentation. Supporting documentation would include physician notes detailing oral lesions, pharyngeal inflammation, and a diagnosis of herpetic origin.

• Do not use this code for other forms of herpes simplex infections, such as recurrent oral herpes (cold sores) without pharyngeal involvement.
• Ensure the documentation specifies both gingivostomatitis and pharyngotonsillitis to accurately assign this code.
• Consider sequencing this code as the primary diagnosis when it is the reason for the encounter.