ICD-10 Code A58: Granuloma inguinale (donovanosis) coding guide

Key Takeaways

ICD-10 Code A58 is the single billable diagnosis code for granuloma inguinale (donovanosis), a sexually transmitted bacterial infection caused by Klebsiella granulomatis.

Diagnosis requires laboratory confirmation through demonstration of Donovan bodies in crushed-tissue smears stained with Giemsa or Wright stain.

A58 sits under ICD-10-CM block A50-A64 (Infections with a predominantly sexual mode of transmission) and has no subcategory codes beneath it.

Pabau’s claims management software helps sexual health clinics code and submit A58 diagnoses accurately while maintaining HIPAA-compliant patient records.

ICD-10 Code A58 is the designated billable code for the condition called granuloma inguinale, or donovanosis, and understanding exactly when and how to use it separates accurate documentation from costly errors. This article covers the clinical definition, diagnostic criteria, coding guidelines, differential diagnosis distinctions, and documentation best practices for A58.

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes as mandated by the Centers for Medicare and Medicaid Services (CMS). For sexual health providers, this makes precise code selection essential for both billing accuracy and compliance with public health STI reporting frameworks.

Granuloma inguinale diagnosis code A58

ICD-10 Code A58 covers granuloma inguinale, also known as donovanosis. The condition is a chronic, progressive bacterial infection of the skin and subcutaneous tissue of the anogenital region, caused by Klebsiella granulomatis (formerly classified as Calymmatobacterium granulomatis).

The WHO’s ICD-10 classification places A58 within Chapter I: Certain Infectious and Parasitic Diseases (A00-B99), specifically under the block A50-A64 covering infections with a predominantly sexual mode of transmission. The condition is formally defined as anogenital ulcers caused by Klebsiella granulomatis, as distinguished from lymphogranuloma inguinale, which is caused by Chlamydia trachomatis and coded separately as A55.

A58 is a terminal code with no subcategory codes beneath it. It is fully billable and requires no additional specificity digits. The CDC/NCHS ICD-10-CM web tool confirms A58 as valid for the current fiscal year with no pending retirements or revisions.

Donovanosis coding: Applicable terminology and synonyms

The ICD-10-CM tabular list includes “Donovanosis” as an official “Applicable To” term under A58. Coders may encounter either term in clinical documentation. Both map to the same code.

Additional synonyms used in clinical notes and referring documentation include:

• Complicated donovanosis
• Donovanosis, anogenital ulcer
• Donovanosis, non-genital
• Granuloma venereum
• Granuloma pudendi tropicum

When any of these terms appear in a provider’s diagnosis note, ICD-10 Code A58 is the correct code assignment. Non-genital presentations (extragenital donovanosis affecting the oral cavity, inguinal nodes, or other sites) still map to A58; there is no separate code for non-genital involvement.

Sexually transmitted infection ICD-10-CM hierarchy for A58

Understanding where A58 sits within the classification hierarchy helps coders cross-reference related codes and apply the correct block-level instructional notes.

Block A50-A64 carries instructional notes that apply to all codes within it, including A58. Coders working with patients who have a co-existing HIV infection should review whether an additional code is required to identify the HIV status (see the co-infection coding guidance in the related codes section below).

For sexual health clinics managing STI documentation at volume, embedding the A50-A64 block hierarchy into your practice management system’s code library reduces lookup time and supports accurate code selection at point of care.

Diagnostic criteria and Donovan body confirmation

Coding A58 requires that the clinical record support the diagnosis of granuloma inguinale. Unlike some STI codes that can be assigned on clinical presentation alone, the ICD-10-CM clinical notes for A58 specify that diagnosis is made by demonstration of typical intracellular Donovan bodies in crushed-tissue smears.

What are Donovan bodies?

Donovan bodies are intracytoplasmic inclusion bodies visible within mononuclear cells. They represent encapsulated clusters of Klebsiella granulomatis organisms and are the pathognomonic finding for granuloma inguinale. A positive tissue smear is the gold-standard confirmatory test.

Laboratory confirmation typically involves one of these two staining methods:

• Giemsa stain: Most commonly used; Donovan bodies appear as dark blue or black safety-pin-shaped coccobacilli within the cytoplasm of large mononuclear cells.
• Wright stain: Alternative method yielding comparable morphological detail for identifying the characteristic bipolar staining pattern.

Tissue samples are obtained by punch biopsy or by pressing a clean slide directly against the ulcer base (a “crush preparation”). The laboratory confirmation report should specify both the method used and the positive finding. This detail is critical for the clinical record supporting A58 assignment.

Clinical presentation to document

Beyond the laboratory finding, thorough documentation should capture the clinical presentation at the time of diagnosis. Granuloma inguinale progresses through four recognized morphological stages:

1. Ulcero-granulomatous: Single or multiple beefy-red ulcers that bleed easily on contact, the most common presentation.
2. Hypertrophic (verrucous): Irregular raised edges with a walnut-like surface.
3. Necrotic: Deep, foul-smelling ulcers causing tissue destruction.
4. Sclerotic (cicatricial): Fibrous tissue formation, often with scarring and lymphedema.

Documenting the stage and anatomical site, whether penile, vulvar, perianal, inguinal, or extragenital, strengthens the specificity of the clinical record and supports both A58 assignment and public health notification requirements.

Manage STI coding and documentation in one place

Pabau helps sexual health clinics maintain accurate ICD-10 diagnoses, compliant patient records, and streamlined billing workflows, so your team spends less time on paperwork and more time on patient care.

Book a demo

Differential diagnosis coding: A58 vs. A55 and A57

Three conditions within the A50-A64 block present with genital ulceration and are frequently confused in documentation. Assigning the wrong code is a common error with real consequences for treatment tracking and STI surveillance reporting.

A critical distinction: the ICD-10-CM clinical information for A58 explicitly notes that granuloma inguinale is distinguished from lymphogranuloma inguinale caused by Chlamydia trachomatis. “Lymphogranuloma inguinale” is a historical synonym for lymphogranuloma venereum (A55), not for granuloma inguinale (A58). The similar terminology is a well-documented source of coding errors.

When documentation is ambiguous or the clinician has not specified a confirmed causative organism, coders should query the provider rather than assign a default code. Accurate STI coding supports both compliance management obligations and the public health surveillance data that informs CDC disease tracking.

Documentation requirements for A58

Accurate documentation is the foundation of defensible A58 coding. Insufficient records are the primary reason claims involving rare STI codes face payer scrutiny or denial on audit.

What the clinical record must include

For A58 to be coded with confidence, the clinical record should contain all of the following elements:

• Confirmed diagnosis statement: The provider must document “granuloma inguinale” or “donovanosis” as the confirmed diagnosis, not as a rule-out or differential.
• Laboratory confirmation: The report demonstrating Donovan bodies in a crushed-tissue smear, including the staining method and the interpreting laboratory’s findings.
• Anatomical site: Specific location of the lesion (penile shaft, labia, perianal region, inguinal skin, or extragenital site).
• Clinical description: Morphological stage and size of the ulceration, bleeding characteristics, and associated symptoms.
• Treatment plan: The antibiotic regimen initiated (doxycycline, azithromycin, ciprofloxacin, or erythromycin per current guidelines) supports medical necessity.

Clinics using structured patient record software can build STI-specific documentation templates that prompt clinicians to capture all required fields at the point of consultation, reducing the risk of incomplete records reaching the billing team.

Public health reporting considerations

Granuloma inguinale is not on the CDC’s list of nationally notifiable diseases (it was removed from the national list in 1995), but it is a reportable condition in some U.S. states. Where it is reportable, confirmed cases must be reported to state or local health departments. This reporting obligation is separate from the billing code assignment but is triggered by the same confirmed diagnosis that supports A58 coding.

Jurisdiction-specific reporting forms and timelines vary by state. Providers should verify their state health department’s current requirements for donovanosis notification, as some states require reporting within 24 hours of laboratory confirmation while others allow a longer window. This does not affect code assignment but should be part of the standard STI workflow at any sexual health clinic.

Related ICD-10 codes and co-infection coding

A58 does not exist in isolation within the coding landscape. Several adjacent codes and instructional notes affect how A58 interacts with concurrent diagnoses.

Codes within block A50-A64

The following codes from the same block are most likely to appear alongside A58 in practice:

• A55: Lymphogranuloma venereum (caused by Chlamydia trachomatis serovars L1-L3). Distinct from A58; do not conflate.
• A57: Chancroid (caused by Haemophilus ducreyi). Painful ulcers; laboratory culture confirms the organism.
• A59: Trichomoniasis. Commonly co-diagnosed; code separately when both conditions are confirmed.
• A60: Anogenital herpesviral (herpes simplex) infections. Often in the differential for genital ulcers; laboratory PCR or culture distinguishes from A58.
• A64: Unspecified sexually transmitted disease. Use only when the causative organism is genuinely unknown after investigation; never as a substitute for a confirmed specific code.

HIV co-infection coding

When a patient has both confirmed granuloma inguinale and an existing HIV infection, ICD-10-CM instructional notes within Chapter I require the use of additional codes to identify all manifestations of HIV infection. The standard sequencing practice is:

1. B20 (Human immunodeficiency virus [HIV] disease) as the principal diagnosis if HIV is the primary condition being managed.
2. A58 as an additional code to identify the concurrent STI.

If the encounter is specifically for treatment of the granuloma inguinale and the HIV status is incidental, the sequencing may be reversed depending on the circumstances of the visit. Coders should apply the Uniform Hospital Discharge Data Set (UHDDS) definition of principal diagnosis and the ICD-10-CM Official Guidelines Section II when making this determination. The AAPC Codify platform provides detailed coding guidance for HIV co-infection sequencing scenarios.

CPT codes commonly reported with A58

While A58 is a diagnosis code, the following CPT procedure codes are routinely billed on the same claim:

• 99213 / 99214: Office visit evaluation and management (level 3 or 4 depending on complexity).
• 87252 / 87255: Viral culture for herpes simplex virus (to rule out herpetic ulceration in the differential).
• 11104: Punch biopsy of skin (for tissue smear collection to demonstrate Donovan bodies).
• 87999: Unlisted microbiology procedure (used when the specific Klebsiella granulomatis PCR test does not have an assigned CPT code at the time of billing).

Pairing the correct CPT procedure codes with A58 reduces the risk of medical necessity denials by demonstrating that the evaluation, specimen collection, and laboratory confirmation steps were performed. Using integrated claims management software that links diagnosis codes to procedure codes at claim generation helps catch unbundling or mismatched pairing issues before submission.

Conclusion

Granuloma inguinale is a rare but clinically significant STI with one specific home in the ICD-10-CM classification: A58. Accurate use of this code depends on laboratory-confirmed Donovan body findings, clear distinction from A55 and A57 at the differential diagnosis stage, and thorough clinical documentation that captures the site, stage, and treatment plan.

For sexual health practices managing STI documentation at scale, Pabau’s digital forms and integrated patient record tools make it straightforward to capture every required documentation element at the point of care, reducing audit risk and supporting accurate claim submission. To see how Pabau handles STI coding workflows end to end, book a demo.

Continue your research

Managing a sexual health or STI clinic? Sexual health clinic software covers how Pabau supports STI documentation, compliance workflows, and patient record management.

Concerned about coding compliance and audit readiness? Compliance management software helps clinics maintain defensible records across all diagnosis code categories.

Frequently Asked Questions