Health Information Management

Coxsackie virus

JustCoding News: Outpatient, September 23, 2009

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Coxsackie is a common enterovirus, second only to rhinovirus (also known as the common cold). There are 23 Coxsackie type A viruses and six Coxsackie type B viruses.

Enteroviruses are small viruses made up of ribonucleic acid and protein. Infants, children, adolescents, and pregnant women are especially susceptible to infection and illness. However, adults with compromised immune systems also are susceptible.


There are two types of Coxsackie virus:

  • Type A: This causes herpangina (i.e., painful blisters in the mouth, throat, hands, and feet). Hand, foot, and mouth disease is the most common name for this viral infection. It usually occurs in children younger than 10, but adults also can develop the condition. Type A can also cause conjunctivitis (i.e., inflammation of the eyelids and the white area of the eye).
  • Type B: This causes epidemic pleurodynia (i.e., fever, lung, and abdominal pain with headache), which can last approximately two to 12 days. This is commonly called Bornholm disease.

Both types A and B Coxsackie viruses can cause meningitis, myocarditis, and pericarditis; however, these conditions are less common. There also may be a link between the Coxsackie virus and Type I juvenile diabetes.

Infection usually spreads by fecal matter or respiratory secretions such as saliva, sputum, or nasal mucus, through direct contact with either the contaminated secretions or contaminated surfaces such as toys, doorknobs, and tables. A pregnant woman can pass the infection on to her baby and should therefore be extremely cautious when signs or symptoms of the disease present.

Signs and symptoms

Most people who become infected never become ill. Those who become ill either develop mild upper respiratory or flu-like symptoms (e.g., fever and muscle aches) or an illness with a rash.

Rarely, a patient may develop myocarditis, encephalitis, or even paralysis. Generally, patients with mild illness fully recover. Those who develop more severe complications such as paralysis, encephalitis, or cardiomyopathy likely require long-term care.


Currently, there are no vaccinations for the Coxsackie virus. Because most people who become infected do not become ill, it is very difficult to prevent the spread of the virus. As with all viruses, the CDC recommends general cleanliness and frequent hand washing.

Documentation and coding

ICD-9-CM coding

  • Coxsackie virus: Report code 079.2
  • Specific diseases due to Coxsackie virus: Report 074.x (fourth digit required)
    • Herpangina: 074.0
    • Epidemic pleurodynia: 074.1
    • Coxsackie carditis: 074.2x (fifth digit required)
    • Hand, foot, and mouth disease: 074.3
    • Other specified diseases due to Coxsackie virus 074.8

Here are some examples:

  • When Coxsackie virus affects the heart (e.g., pericarditis caused by Coxsackie), the alphabetic index of the ICD-9-CM Manual requires code 074.21.
  • If the diagnosis is meningitis due to Coxsackie, report code 047.0 (Meningitis due to enterovirus).
  • If the Coxsackie is linked to conditions in the central nervous system, refer to code category 048.
  • Report code 008.67 for enteritis due to the Coxsackie virus.

It is not necessary to code the causative organism separately from the condition, as these all are combination codes that identify both the condition and the organism.

ICD-10 coding

  • Enterovirus infection, unspecified including coxsackievirus infection not otherwise specified and echovirus infection not otherwise specified: Report code B34.1
  • Viral carditis, unspecified: Report code B33.20
  • Viral endocarditis: Report code B33.21
  • Viral myocarditis: Report code B33.22
  • Viral pericarditis: Report code B33.23
  • Viral cardiomyopathy: Report code B33.24

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