ICD-10 Coding for Male Partner Treatment in Recurrent Bacterial Vaginosis
Use ICD-10 code Z20.6 (Contact with and exposure to infections with a predominantly sexual mode of transmission) for the male partner seeking treatment, as this reflects exposure to a sexually-associated condition without the partner having the disease themselves.
Critical Evidence Review
The premise of your question contains a significant clinical contradiction that must be addressed:
Current Guideline Position on Partner Treatment
- Established guidelines explicitly state that male partner treatment is NOT recommended for bacterial vaginosis. 1
- The CDC guidelines clearly indicate that "treatment of sex partners in clinical trials has not influenced the woman's response to therapy, nor has it influenced the relapse or recurrence rate. Therefore, routine treatment of sex partners is not recommended." 1
- The principal goal of BV therapy is to relieve vaginal symptoms in women, and preventing transmission to men is not a goal of therapy because male partners are not symptomatic. 1, 2, 3
Recent Research Findings
- A 2021 randomized, double-blind, placebo-controlled trial found that male partner treatment with metronidazole did NOT significantly reduce BV recurrence in female partners (81% failure in metronidazole arm vs 80% in placebo arm, P > .999). 4
- However, this same study found that women whose male partners adhered to study medication were less likely to fail treatment (adjusted relative risk 0.85, P = .035). 4
The Coding Dilemma
There is no ICD-10 code specifically designed for treating an asymptomatic male partner of a woman with recurrent BV because this is not standard-of-care treatment. The available guidelines from 1993 through current summaries consistently recommend against this practice. 1, 2, 3, 5
Practical Coding Options
If you proceed with treatment despite guideline recommendations:
- Z20.6 (Contact with and exposure to infections with a predominantly sexual mode of transmission) - This is the most appropriate code as it captures sexual exposure without implying the partner has the disease
- Z71.89 (Other specified counseling) - Could be used if framing this as preventive counseling/treatment
- Z11.3 (Encounter for screening for infections with a predominantly sexual mode of transmission) - Less appropriate but possible
Important Caveats
- Insurance coverage may be denied because partner treatment for BV is not guideline-concordant care. 1, 3, 5
- The FDA labeling for metronidazole includes treatment of trichomoniasis partners ("asymptomatic sexual partners of treated patients should be treated simultaneously") but makes no mention of BV partner treatment. 6
- BV is associated with sexual activity, but sexual transmission has not been definitively proven, and treatment of partners has historically not been shown to prevent recurrence. 5, 7
Documentation Recommendations
If treating the male partner, document:
- The recurrent nature of the female partner's BV
- Discussion of the lack of guideline support for this approach
- The 2021 trial data showing mixed results 4
- Shared decision-making with the patient
- That this represents off-guideline treatment
The most defensible approach is to counsel the male partner that current evidence does not support his treatment, while acknowledging the emerging but inconclusive data suggesting possible benefit with strict medication adherence. 4