A68.9 ICD-10-CM Code: Relapsing fever, unspecified

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for A68.9 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on A68.9 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for A68.9

MedCoder structured workflow — derived from this code’s own official record

Before you code A68.9

1. Unspecified does not mean incorrect. When the record gives no greater specificity, A68.9 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

   ReviewA68.0, A68.1

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

Choose the right path

1. Does the record document the detail a more specific sibling code needs?
   Yes → Review the specific siblings in this subcategory.
   No → Continue — A68.9 is appropriate when the documentation goes no further.

   ReviewA68.0, A68.1

Consider A68.9. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes2 — not part of A68.9(3 notes)

  Coding workflow: The conditions named in this note are not included in A68.9. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareA69.2, A27

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (7)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Fever (inanition) (of unknown origin) (persistent) (with chills) (with rigor), relapsing (Borrelia)
• Fever (inanition) (of unknown origin) (persistent) (with chills) (with rigor), relapsing (Borrelia), Koch's
• Koch's, relapsing fever
• Novy's relapsing fever
• Relapsing fever
• Relapsing fever, Koch's
• Relapsing fever, Spirillum

Don’t confuse A68.9 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of A68.9 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• A69.2— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of Lyme disease adds A69.2; it is not part of this code and both may be reported when both are documented.

  Full comparison: A68.9 vs A69.2 →

• A27— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of leptospirosis adds A27; it is not part of this code and both may be reported when both are documented.

  Full comparison: A68.9 vs A27 →

• A50— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of syphilis adds A50; it is not part of this code and both may be reported when both are documented.

  Full comparison: A68.9 vs A50 →

• A53— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of syphilis adds A53; it is not part of this code and both may be reported when both are documented.

  Full comparison: A68.9 vs A53 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 56 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 867 (MDC 18), DRG 868 (MDC 18), DRG 869 (MDC 18).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INF009 — Parasitic, other specified and unspecified infections (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

A44.0 — Systemic bartonellosis, A44.1 — Cutaneous and mucocutaneous bartonellosis, A44.8 — Other forms of bartonellosis, A44.9 — Bartonellosis, unspecified, A68.0 — Louse-borne relapsing fever, A68.1 — Tick-borne relapsing fever, A69.20 — Lyme disease, unspecified, A69.21 — Meningitis due to Lyme disease, A69.22 — Other neurologic disorders in Lyme disease, A69.23 — Arthritis due to Lyme disease, A69.29 — Other conditions associated with Lyme disease, A75.0 — Epidemic louse-borne typhus fever due to Rickettsia prowazekii, A75.1 — Recrudescent typhus [Brill's disease], A75.2 — Typhus fever due to Rickettsia typhi, A75.3 — Typhus fever due to Rickettsia tsutsugamushi, A75.9 — Typhus fever, unspecified, A77.0 — Spotted fever due to Rickettsia rickettsii, A77.1 — Spotted fever due to Rickettsia conorii, A77.2 — Spotted fever due to Rickettsia siberica, A77.3 — Spotted fever due to Rickettsia australis, +35 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Parasitic, other specified and unspecified infections).

A66.7 — Other manifestations of yaws, A66.8 — Latent yaws, A66.9 — Yaws, unspecified, A67.0 — Primary lesions of pinta, A67.1 — Intermediate lesions of pinta, A67.2 — Late lesions of pinta, A67.3 — Mixed lesions of pinta, A67.9 — Pinta, unspecified, A68.0 — Louse-borne relapsing fever, A68.1 — Tick-borne relapsing fever, A69.0 — Necrotizing ulcerative stomatitis, A69.1 — Other Vincent's infections, A69.20 — Lyme disease, unspecified, A69.21 — Meningitis due to Lyme disease, A69.22 — Other neurologic disorders in Lyme disease, A69.23 — Arthritis due to Lyme disease, A69.29 — Other conditions associated with Lyme disease, A69.8 — Other specified spirochetal infections, A69.9 — Spirochetal infection, unspecified, A75.0 — Epidemic louse-borne typhus fever due to Rickettsia prowazekii, +235 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Fever”; these codes share that main term but sit in a different category of the Tabular List.

A25.9 — Rat-bite fever, unspecified (rat-bite), A27.0 — Leptospirosis icterohemorrhagica (icterohemorrhagic), A27.89 — Other forms of leptospirosis (seven day), A27.9 — Leptospirosis, unspecified (mud), A28.1 — Cat-scratch disease (cat-scratch), A38.9 — Scarlet fever, uncomplicated (scarlet), A39.0 — Meningococcal meningitis (petechial), A44.0 — Systemic bartonellosis (Oroya), A48.2 — Nonpneumonic Legionnaires' disease [Pontiac fever] (Pontiac), A48.4 — Brazilian purpuric fever (Brazilian purpuric), A70 — Chlamydia psittaci infections (parrot), A75.0 — Epidemic louse-borne typhus fever due to Rickettsia prowazekii (famine), A75.2 — Typhus fever due to Rickettsia typhi (Mexican), A75.3 — Typhus fever due to Rickettsia tsutsugamushi (kedani), A75.9 — Typhus fever, unspecified (Canton), A77.0 — Spotted fever due to Rickettsia rickettsii (Bullis), A77.1 — Spotted fever due to Rickettsia conorii (Kenya), A77.2 — Spotted fever due to Rickettsia siberica (North Asian tick-borne), A77.3 — Spotted fever due to Rickettsia australis (Queensland), A77.40 — Ehrlichiosis, unspecified (spotted, Ehrlichiosis), +107 more

Contextual Map

Every relationship of A68.9 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

• A00-B99 — Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) (A00-B99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• A65-A69 — Other spirochetal diseases[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Clinical classification (CCSR)

• INF009 — Parasitic, other specified and unspecified infections[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 867 — OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC[MS-DRG]: “OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 868 — OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC[MS-DRG]: “OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 869 — OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC[MS-DRG]: “OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 18 — Infectious and Parasitic Diseases, Systemic or Unspecified Sites[MDC crossing]: “Infectious and Parasitic Diseases, Systemic or Unspecified Sites — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Fever (inanition) (of unknown origin) (persistent) (with chills) (with rigor), relapsing (Borrelia)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Fever (inanition) (of unknown origin) (persistent) (with chills) (with rigor), relapsing (Borrelia), Koch's[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Koch's, relapsing fever[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Novy's relapsing fever[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Relapsing fever[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Relapsing fever, Koch's[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Relapsing fever, Spirillum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• A68 — Relapsing fevers[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• A68.0 — Louse-borne relapsing fever[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• A68.1 — Tick-borne relapsing fever[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to A68.9 in its code family, with their registry titles.

• A68 — Relapsing fevers
• A68.0 — Louse-borne relapsing fever
• A68.1 — Tick-borne relapsing fever

View all codes in the A68 family