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v1.0.0
ICD-10 Guide
ICD-10 CodesB37.0

B37.0

Candidal stomatitis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 B37.0 is a billable code used to indicate a diagnosis of candidal stomatitis.

Key Diagnostic Point:

Candidal stomatitis, commonly known as oral thrush, is a fungal infection of the oral mucosa caused by the overgrowth of Candida species, primarily Candida albicans. This condition is characterized by white patches on the tongue, inner cheeks, gums, and sometimes the throat, which can be painful and may bleed when scraped. It is often seen in immunocompromised patients, including those with HIV/AIDS, diabetes, or those undergoing chemotherapy. The infection can also occur in healthy individuals, particularly in cases of poor oral hygiene, use of antibiotics, or corticosteroids. Symptoms may include soreness, difficulty swallowing, and a cottony feeling in the mouth. Diagnosis is typically made through clinical examination and may be confirmed with a culture of the oral lesions. Treatment usually involves antifungal medications such as nystatin or fluconazole, and addressing any underlying conditions is crucial for effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between candidal stomatitis and other oral lesions
  • Identifying underlying immunocompromised states
  • Variability in presentation among different patient populations
  • Need for accurate documentation of symptoms and treatment response

Audit Risk Factors

  • Inadequate documentation of symptoms and treatment
  • Failure to note underlying immunocompromised conditions
  • Misclassification of candidal stomatitis as a more severe condition
  • Lack of follow-up documentation to support ongoing treatment

Specialty Focus

Medical Specialties

Dentistry

Documentation Requirements

Detailed clinical notes on oral examination findings and treatment plans.

Common Clinical Scenarios

Patients presenting with oral lesions, especially in those with a history of antibiotic use or immunocompromised status.

Billing Considerations

Ensure to document the extent of lesions and any patient-reported symptoms.

Infectious Disease

Documentation Requirements

Comprehensive history of immunocompromised conditions and treatment regimens.

Common Clinical Scenarios

Patients with HIV/AIDS or those undergoing immunosuppressive therapy presenting with oral thrush.

Billing Considerations

Document any systemic symptoms and the response to antifungal therapy.

Coding Guidelines

Inclusion Criteria

Use B37.0 When
  • According to ICD
  • 10 guidelines, B37
  • 0 should be used when the condition is specifically diagnosed as candidal stomatitis
  • It is important to document any underlying conditions that may contribute to the infection

Exclusion Criteria

Do NOT use B37.0 When
  • Exclusion criteria include other types of stomatitis not caused by Candida

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when evaluating a patient with candidal stomatitis.

Documentation Requirements

Document history, examination findings, and treatment plan.

Specialty Considerations

Ensure thorough documentation of oral examination findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of candidal infections, improving the ability to track and manage these conditions in various patient populations, particularly those who are immunocompromised.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of candidal infections, improving the ability to track and manage these conditions in various patient populations, particularly those who are immunocompromised.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of candidal infections, improving the ability to track and manage these conditions in various patient populations, particularly those who are immunocompromised.

Resources

Clinical References

  • •
    CDC - Candidiasis

Coding & Billing References

  • •
    CDC - Candidiasis

Frequently Asked Questions

What are the common treatments for candidal stomatitis?

Common treatments include topical antifungals like nystatin and systemic antifungals such as fluconazole, depending on the severity and underlying conditions.