ICD-10 Coding for Oropharyngeal Thrush(B37.0, B37.81)
Complete ICD-10-CM coding and documentation guide for Oropharyngeal Thrush. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Oropharyngeal Thrush
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 there are visible plaques in the mouth confirmed by lab tests. |
|
| B37.81 | Candidal esophagitis | Use when thrush extends to the esophagus, confirmed by endoscopy. |
|
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 thrush
Essential facts and insights about Oropharyngeal Thrush
Primary ICD-10-CM Codes for oropharyngeal thrush
Decision Criteria
clinical Criteria
- Presence of white plaques on oral mucosa
documentation Criteria
- KOH prep or culture confirming Candida
Applicable To
- Oral thrush
- Oropharyngeal candidiasis
Excludes
- Candidal esophagitis (B37.81)
Clinical Validation Requirements
- White curd-like patches on oral mucosa/tongue
- Confirmed by KOH prep or culture
Code-Specific Risks
- Misidentifying the location of candidiasis can lead to incorrect coding.
Coding Notes
- Ensure documentation specifies the presence of oral lesions and any associated conditions.
B37.81 - Candidal esophagitis
Use when thrush extends to the esophagus, confirmed by endoscopy.
Applicable To
- Esophageal candidiasis
Excludes
- Candidal stomatitis (B37.0)
Clinical Validation Requirements
- Dysphagia with endoscopic evidence of white exudate in esophagus
Coding Notes
Ensure documentation includes endoscopic findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
HIV disease
B20Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Oropharyngeal Thrush 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., Regulatory: Increases risk of audit., Financial: Potential for denied claims.
Mitigation Strategy
Always specify the location of lesions., Use lab tests to confirm diagnosis.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit due to lack of specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Query provider for specific location and use appropriate code.
Impact
Using B37.9 when specific site is known.
Mitigation Strategy
Ensure documentation specifies the site of infection.
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 Thrush, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Oropharyngeal Thrush
Use these documentation templates to ensure complete and accurate documentation for Oropharyngeal Thrush. These templates include all required elements for proper coding and billing.
Primary Care Visit for Oral Thrush
Specialty: Primary CareRequired Elements
- Chief complaint
- Oral examination findings
- Lab results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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