Find comprehensive information on mononucleosis diagnosis, including clinical documentation, medical coding (ICD-10 code B27), Epstein-Barr virus (EBV) testing, and symptoms like fatigue, sore throat, and swollen lymph nodes. Learn about the infectious mononucleosis diagnostic criteria, differential diagnosis considerations, and treatment options for healthcare professionals. This resource covers mononucleosis diagnosis management, clinical findings, and relevant medical terminology for accurate documentation and coding.
Also known as
Infectious mononucleosis
Covers infectious mononucleosis caused by the Epstein-Barr virus.
Cytomegaloviral disease
Includes other viral diseases like cytomegalovirus, which can have similar symptoms.
Malaise and fatigue
Includes nonspecific symptoms like fatigue, often present in mononucleosis.
When to use each related code
| Description |
|---|
| Infectious mononucleosis |
| Strep throat |
| Cytomegalovirus (CMV) |
Using unspecified codes (e.g., B27.9) when clinical documentation supports a more specific mononucleosis diagnosis (e.g., B27.0).
Overlooking CMV mononucleosis (B25.1) when symptoms and lab results suggest CMV infection rather than EBV mononucleosis.
Failing to capture and code complications of mononucleosis, such as splenic rupture (S36.0) or hepatitis (B15-B19), impacting reimbursement and quality metrics.
Q: What are the most reliable diagnostic tests for acute infectious mononucleosis in adolescents, considering sensitivity, specificity, and cost-effectiveness?
A: Diagnosing acute infectious mononucleosis (AIM) in adolescents requires a strategic approach balancing sensitivity, specificity, and cost-effectiveness. The heterophile antibody test (Monospot) is often the first line due to its rapid turnaround time and lower cost. However, its sensitivity can be lower in the first week of illness. For patients with negative Monospot results but persistent symptoms suggestive of AIM, consider EBV-specific antibody testing (IgM and IgG against viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA)). A positive IgM VCA and negative EBNA IgG confirms acute infection. Explore how combining Monospot with EBV serology can improve diagnostic accuracy in challenging cases. Consider implementing a diagnostic algorithm based on symptom duration and Monospot results to optimize resource utilization.
Q: How can I differentiate mononucleosis from other conditions with similar symptoms, such as streptococcal pharyngitis, cytomegalovirus (CMV), and acute HIV infection, in a primary care setting?
A: Differentiating mononucleosis from other infections like streptococcal pharyngitis, cytomegalovirus (CMV), and acute HIV can be clinically challenging due to overlapping symptoms. A thorough patient history and physical exam, including assessment of lymphadenopathy, splenomegaly, and pharyngeal exudates, are crucial. While a rapid strep test can rule out strep throat, distinguishing mononucleosis from CMV and acute HIV often requires serologic testing. EBV-specific antibody testing can confirm mononucleosis, while CMV IgM and IgG tests and HIV tests are necessary to rule out those infections. Learn more about the specific antibody patterns for each infection to aid in accurate diagnosis. Consider implementing a structured approach to evaluating patients with suspected mononucleosis to minimize misdiagnosis and ensure appropriate management.
Subjective: Patient presents with complaints of fatigue, sore throat, and swollen lymph nodes. Onset of symptoms approximately one week ago, progressively worsening. Patient reports difficulty swallowing and decreased appetite. Denies cough or runny nose. Reports low-grade fever and chills. Patient mentions close contact with individuals diagnosed with mononucleosis. Social history includes college student living in dormitory. Family history noncontributory. Objective: Physical examination reveals enlarged, tender cervical lymph nodes. Pharynx is erythematous with tonsillar exudates. Mild splenomegaly palpable. Temperature 100.8 degrees Fahrenheit. Hepatosplenomegaly noted on exam. No other significant findings. Assessment: Based on the patient's presenting symptoms, physical examination findings, and reported exposure, the diagnosis of infectious mononucleosis (mono, kissing disease, glandular fever) is suspected. Differential diagnoses include strep throat, cytomegalovirus (CMV), and other viral infections. Plan: Mononucleosis blood test (Monospot) ordered to confirm the diagnosis. Complete blood count (CBC) with differential to assess lymphocyte count and atypical lymphocytes. Liver function tests (LFTs) to evaluate liver involvement. Patient education provided regarding supportive care, including rest, hydration, and over-the-counter pain relievers for fever and sore throat management. Advised to avoid contact sports due to risk of splenic rupture. Follow-up appointment scheduled in one week to review test results and assess symptom improvement. ICD-10 code B27 will be used for billing purposes pending confirmatory testing. Patient instructed to return if symptoms worsen or new symptoms develop.