2025 ICD-10-CM code A69.20
Lyme disease, unspecified.
Medical necessity for treatment of Lyme disease is established by confirming the diagnosis through clinical findings and laboratory tests.Treatment is necessary to prevent the progression of the disease and the development of serious long-term complications involving the joints, heart, and nervous system.
The provider is responsible for diagnosing Lyme disease based on patient history, symptoms (such as rash, fever, headache, fatigue, joint pain), and laboratory tests (such as EIA and Western blot).Treatment typically involves antibiotics like doxycycline, amoxicillin, or cefuroxime axetil, with intravenous antibiotics like ceftriaxone or penicillin reserved for severe cases with neurologic or cardiac involvement.
In simple words: This code is used when a person has Lyme disease, a bacterial infection spread by ticks, but the doctor hasn't specified what kind of Lyme disease it is or what problems it is causing.
Lyme disease is a bacterial infection transmitted to humans through the bite of infected blacklegged ticks.This code indicates Lyme disease without any further specification as to its manifestation (e.g., neurologic, cardiac, or arthritic).
Example 1: A patient presents with a characteristic erythema migrans rash, fever, headache, and fatigue after a recent hiking trip in a Lyme-endemic area. Blood tests confirm Lyme disease. The code A69.20 is used as no specific manifestation is yet documented., A patient reports joint pain and swelling several months after a suspected tick bite.Laboratory testing is positive for Lyme disease. Since the specific type of Lyme disease is not documented, A69.20 is used., A patient with a history of untreated Lyme disease presents with neurological symptoms.Further investigation determines that these symptoms are not directly attributable to Lyme disease. Code A69.20 is used to document the history of Lyme disease. Additional codes would be used for the current presenting neurologic symptoms.
Documentation should include evidence of tick exposure or suspected tick bite, clinical signs and symptoms (e.g., erythema migrans rash, fever, fatigue, joint pain), and laboratory test results (e.g. EIA, Western blot).If the Lyme disease has manifested into specific complications (neuroborreliosis, Lyme carditis, Lyme arthritis) this must also be documented to support use of more specific codes.
- Payment Status: Active
- Specialties:Infectious disease, Internal medicine, Family medicine, Emergency medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital,Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home