ICD-10 Coding for Oropharyngeal Candidiasis(B37.0, B37.81)
Complete ICD-10-CM coding and documentation guide for Oropharyngeal Candidiasis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Oropharyngeal Candidiasis
B37.0-B37.9Primary Range
Candidiasis
This range includes codes for various forms of candidiasis, with B37.0 specifically for oral thrush.
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 documentation specifies oral thrush with visible plaques and lab confirmation. |
|
| B37.81 | Candidal esophagitis | Use when documentation indicates esophageal involvement. |
|
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 oropharyngeal candidiasis
Essential facts and insights about Oropharyngeal Candidiasis
Primary ICD-10-CM Codes for oropharyngeal candidiasis
Decision Criteria
clinical Criteria
- Presence of white plaques on oral mucosa
documentation Criteria
- KOH prep or culture confirming Candida species
Applicable To
- Oral thrush
- Pseudomembranous candidiasis
Excludes
- Candidal esophagitis (B37.81)
Clinical Validation Requirements
- Presence of white pseudomembranous plaques on buccal mucosa or tongue
- KOH prep positive for fungal hyphae
Code-Specific Risks
- Incorrectly using B37.9 when specific details are available
Coding Notes
- Ensure documentation specifies the type and location of candidiasis.
B37.81 - Candidal esophagitis
Use when documentation indicates esophageal involvement.
Applicable To
- Esophageal candidiasis
Excludes
- Candidal stomatitis (B37.0)
Clinical Validation Requirements
- Endoscopic evidence of esophageal plaques
- Odynophagia with lab confirmation
Coding Notes
Ensure esophageal involvement is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Oral mucositis (ulcerative)
K12.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Oropharyngeal Candidiasis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B37.0.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Train clinicians on detailed documentation practices, Use templates to guide thorough documentation
Impact
Reimbursement: May result in lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines requiring specificity., Data Quality: Decreases data accuracy and quality for clinical records.
Mitigation Strategy
Always specify the type and location of candidiasis to use the most accurate code.
Impact
Risk of audits due to non-specific coding of candidiasis.
Mitigation Strategy
Ensure detailed documentation and use of specific codes.
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 Oropharyngeal Candidiasis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Oropharyngeal Candidiasis
Use these documentation templates to ensure complete and accurate documentation for Oropharyngeal Candidiasis. These templates include all required elements for proper coding and billing.
HIV patient with oral thrush
Specialty: Infectious DiseaseRequired Elements
- Description of oral lesions
- Lab confirmation
- Associated conditions (e.g., HIV)
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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