It is a single entity syndrome occurring in pregnancy; not double diagnosis as to give 646.8 and 708.1.
646.8 is not exclusive for Herpes gestationis, but the other specified conditions are not correlated with pruritus, plagues or papules in that category, either.
(PUPPP Syndrome occurs in later months of preg)
Early PUPPP demonstrating urticarial papules and plaques on the abdomen with predilection for striae. More severe case of PUPPP with confluent urticarial plaque on abdomen and lower extremities .
It occurs mostly during late 3rd trimester usually affects women with their first pregnancy. Most women that have PUPPP in their first pregnancy do not experience it again with other pregnancies..
There is no reason to worry about the rash harming mother or baby. The average rash will last around six weeks and it will all go away after delivery. The cause of PUPPP is not fully understood, although researchers believe it may have something to do with the fetal DNA of a male baby. The treatment is symptomatic with ointments and some times steroids The prognosis is exelent.
Pemphigoid gestationis (PG), also known as Herpes gestationis (HG), is an autoimmune bullous disease of pregnancy. Despite its name, this disease has no relationship to herpes simplex virus, but was so called because of the herpes-like nature of the blisters. This dermatosis classically develops in the second or third trimester (mean of 21 weeks).11 It occurs in 1 in 50,000 pregnancies, and has a strong association with HLA-DR3 and HLA-DR4, which might explain the greater prevalence of this condition in white women compared to black women.12
Pemphigoid gestationis begins with the sudden onset of intensely itchy, urticarial lesions, which are found on the abdomen in 50% of cases. At this stage, it is very difficult to distinguish this disease from PUPPP. The lesions then progress to a generalized bullous eruption that usually spares the face, mucous membranes, palms and soles (Figure 4).9 The disease often resolves during the latter part of pregnancy, and flares at delivery or immediately postpartum in more than 60% of cases; 25% of cases appear for the first time after delivery
[Erythematous papules and plaques on abdomen with erosions at sites of previous vesicles in a patient with HG. Immunoglobulin G (IgG) autoantibodies are produced against the target antigen, known as bullous pemphigoid antigen 2 (BPAG2) or BP180 due to its 180-kD size. Bullous pemphigoid antigen 2 is a component of the hemidesmosome, and is critical in epidermal-dermal adhesion. Epitope mapping has demonstrated that PG autoantibodies bind an antigenic site (MCW-1) within the noncollagenous domain (NC16A) of the transmembrane 180-kD PG antigen.]
The binding of IgG to the cutaneous basement membrane is believed to trigger an immune response that leads to the formation of subepidermal vesicles.14 Biopsy results reveal a subepidermal blister with an eosinophil-predominant infiltrate.
The infiltrate is localized to the dermal-epidermal junction and perivascular areas.
Direct Immunofluorescence (DIF) is the most sensitive and specific assay for differentiating PG from PUPPP. Performed on perilesional skin, DIF shows a linear band of C3 and/or IgG at the basement membrane. Salt-split skin studies demonstrate antibody binding to the roof of the vesicle.9
Typically, PG regresses without scarring a few weeks after delivery. Affected women have an increased risk of subsequent development of autoimmune disorders, particularly Graves' disease. There is also a risk that PG will recur in subsequent pregnancies, often with increased severity, or in association with menses or OC use. Infants are not at higher risk for mortality, but may be born small for gestational age or premature. Up to 10% of infants will develop neonatal PG, but the disease abates without sequelae on clearance of maternal antibodies.
Urticaria, commonly known as hives, is a skin reaction pattern characterized by the appearance of itchy (pruritic), red (erythematous) raised welts or lumps called "wheals" on the skin. They usually occur in batches. Chronic utrecaria can be immnnological/ hereditary. Cause may be due to allergy, infection, insect or spider bite or immunological disorder associated. It does not have predeliction to pregnancy and no bearing and waiting for the culmination of pregnancy. It has no affinity for some particular sites of the body too.
Whatever code you give, it is your choice. But let us be fortunate enough to know the general guide acceptance/payers acceptance.
Would the thread Poster/ Initiator make us to know which was the accepted code for the scenario?.
Well, if your code 646.8x IS OF the highest specific, then about hundreds of conditions can be reported into that category during pregnancy-other specific complications of pregnancy( not necessarily COMPLICATING PREGNANCY).