ICD-10 Coding for Candida(B37.0, B37.2, B37.7, B37.9)
Complete ICD-10-CM coding and documentation guide for Candida. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Candida
B37Primary Range
Candidiasis
This range includes all forms of candidiasis, specifying different sites and types of infection.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B37.0 | Candidal stomatitis | Use when oral candidiasis is confirmed by clinical examination or laboratory tests. |
|
| B37.2 | Candidiasis of skin and nail | Use for confirmed skin or nail candidiasis. |
|
| B37.7 | Candidal sepsis | Use when candidemia is confirmed with systemic infection signs. |
|
| B37.9 | Candidiasis, unspecified | Use only when the site or type of candidiasis is not specified. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for oral thrush
Essential facts and insights about Candida
Primary ICD-10-CM Codes for candida
Decision Criteria
clinical Criteria
- Presence of white plaques on oral mucosa
documentation Criteria
- KOH smear positive for yeast
Applicable To
- Oral thrush
- Fungal infection of the tongue
Excludes
- Angular cheilitis (K13.0)
Clinical Validation Requirements
- White plaques on tongue or mucosa
- Confirmed by KOH smear or culture
Code-Specific Risks
- Misuse for unspecified oral infections
Coding Notes
- Ensure documentation specifies oral involvement to avoid using unspecified codes.
B37.2 - Candidiasis of skin and nail
Use for confirmed skin or nail candidiasis.
Applicable To
- Intertrigo
- Onychomycosis due to Candida
Excludes
- Dermatophytosis (B35.-)
Clinical Validation Requirements
- Erythematous rash with satellite lesions
- Biopsy confirms Candida species
Coding Notes
Ensure differentiation from other fungal infections.
B37.7 - Candidal sepsis
Use when candidemia is confirmed with systemic infection signs.
Applicable To
- Sepsis due to Candida species
Excludes
- Sepsis due to other organisms (A41.-)
Clinical Validation Requirements
- Positive blood culture for Candida
- Systemic inflammatory response
Coding Notes
Ensure documentation supports sepsis criteria.
B37.9 - Candidiasis, unspecified
Use only when the site or type of candidiasis is not specified.
Applicable To
- Unspecified Candida infection
Excludes
- Specific site candidiasis (B37.0-B37.8)
Clinical Validation Requirements
- Lack of site-specific documentation
Coding Notes
Avoid using if specific site information is available.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Candida to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B37.0.
Impact
Clinical: Leads to non-specific treatment plans., Regulatory: Fails to meet documentation standards., Financial: Potential for claim denials or audits.
Mitigation Strategy
Always specify the site of infection., Use precise clinical terminology.
Impact
Reimbursement: May lead to incorrect billing and potential denials., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces specificity and accuracy of health records.
Mitigation Strategy
Use site-specific codes like B37.0 for oral candidiasis.
Impact
High frequency of B37.9 usage without site documentation.
Mitigation Strategy
Implement mandatory site documentation in EHR templates.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Candida, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Candida
Use these documentation templates to ensure complete and accurate documentation for Candida. These templates include all required elements for proper coding and billing.
Oral Candidiasis in HIV Patient
Specialty: Infectious DiseaseRequired Elements
- Diagnosis of oral candidiasis
- HIV status and CD4 count
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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