ICD-10 A38.1
Billable / Specific CCScarlet fever with myocarditis
About ICD-10-CM A38.1
ICD-10-CM code A38.1 represents Scarlet fever with myocarditis. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block A38). The 2026 edition of ICD-10-CM A38.1 became effective on October 1, 2025.
Coding Tips for A38.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
A38.1 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inpatient DRG Impact, CC
codes Scarlet fever with myocarditis. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for A38.1
Local Coverage Determinations (LCDs) from CMS MACs that list A38.1 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing A38.1.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but A38.1 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with A38.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert A38.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| A38.1 | 0341 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To A38.1
Other codes in section A30-A49 (Other bacterial diseases).
ICD-10 A38.1, Billing FAQ
Is ICD-10 code A38.1 billable? +
Yes, A38.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is A38.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does A38.1 map to? +
Per CMS GEMs, A38.1 maps to ICD-9 codes: 0341. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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