B00.7
BillableDisseminated herpesviral disease
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B00.7 an HCC code?
Yes. B00.7 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model (and Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for B00.7
For B00.7 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B00.7 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B00.7 is the ICD-10-CM diagnosis code for disseminated herpesviral disease. Herpes simplex virus that has spread throughout the body affecting multiple organ systems, representing a serious systemic infection. B00.7 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering viral infections characterized by skin and mucous membrane lesions (b00-b09).
Under the CMS-HCC V28 risk adjustment model, B00.7 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a community, non-dual, aged base RAF weight of 0.455. The V24 model used during the PY2024–PY2025 transition mapped B00.7 the same way and at the same RAF weight. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code indicates widespread dissemination; document which organs are involved for complete clinical picture. Because B00.7 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B00.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates widespread dissemination; document which organs are involved for complete clinical picture
- •Often requires additional codes to specify affected sites (CNS, liver, etc.)
Clinical Significance
Disseminated herpesviral disease represents systemic spread of herpes simplex virus beyond its typical mucocutaneous distribution, indicating severe immunocompromise or neonatal vulnerability. This is a life-threatening condition with multi-organ involvement that carries high mortality and maps to the high-weight sepsis HCC category.
Documentation Requirements
- ✓Confirmed HSV by viral culture, PCR, or direct fluorescent antibody from affected sites
- ✓Multi-organ involvement documented (which organs: liver, CNS, lungs, adrenals, skin)
- ✓Immunocompromised status documented if applicable (HIV, transplant, chemotherapy, neonatal)
- ✓Viral type specified if known (HSV-1 or HSV-2)
- ✓Severity indicators: ICU admission, organ failure, antiviral therapy regimen
Commonly Confused Codes
- •B00.1 (Herpesviral vesicular dermatitis) — Localized skin herpes; disseminated disease involves multiple organ systems beyond skin
- •B00.4 (Herpesviral encephalitis) — HSV encephalitis is a single-organ manifestation; disseminated disease affects multiple organs
- •A41.9 (Sepsis, unspecified organism) — Disseminated HSV may present like sepsis but has a specific code; do not use generic sepsis codes when HSV is confirmed