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ICD-10 Guide
ICD-10 CodesB38.0

B38.0

Candidal stomatitis

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

Code Description

ICD-10 B38.0 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 cavity 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 roof of the mouth. Patients may experience discomfort, difficulty swallowing, and a cottony feeling in the mouth. Candidal stomatitis is particularly prevalent in immunocompromised individuals, such as those with HIV/AIDS, diabetes, or those undergoing chemotherapy. The infection can also occur in healthy individuals, especially in cases of poor oral hygiene, use of corticosteroids, or prolonged antibiotic therapy, which disrupts the normal oral flora. Diagnosis is typically made through clinical examination and may be confirmed by culture or microscopic examination of the lesions. Treatment usually involves antifungal medications, such as nystatin or fluconazole, and addressing any underlying conditions that may contribute to the infection. Proper oral hygiene and regular dental check-ups are essential for prevention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of immunocompromised status.
  • Failure to document antifungal treatment and patient response.
  • Misclassification of candidal stomatitis as a different oral condition.
  • Lack of follow-up documentation for recurrent cases.

Specialty Focus

Medical Specialties

Dentistry

Documentation Requirements

Detailed clinical notes on oral examination findings, treatment plans, and patient education.

Common Clinical Scenarios

Patients presenting with oral lesions, difficulty swallowing, or complaints of oral discomfort.

Billing Considerations

Documentation should include any relevant medical history, especially immunocompromised conditions.

Infectious Disease

Documentation Requirements

Comprehensive patient history, including immunocompromised status and previous infections.

Common Clinical Scenarios

Patients with recurrent candidal infections or those undergoing immunosuppressive therapy.

Billing Considerations

Consideration of systemic antifungal therapy and monitoring for treatment efficacy.

Coding Guidelines

Inclusion Criteria

Use B38.0 When
  • According to ICD
  • 10 guidelines, B38
  • 0 should be used when the diagnosis of candidal stomatitis is confirmed
  • It is important to document any underlying conditions that may predispose the patient to this infection

Exclusion Criteria

Do NOT use B38.0 When
  • Exclusion criteria include other types of stomatitis or oral lesions 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

Dentists and infectious disease specialists should ensure thorough documentation.

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 accuracy of data collection and treatment tracking. This specificity aids in better understanding the epidemiology of candidal stomatitis and its association with immunocompromised states.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of candidal infections, improving the accuracy of data collection and treatment tracking. This specificity aids in better understanding the epidemiology of candidal stomatitis and its association with immunocompromised states.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of candidal infections, improving the accuracy of data collection and treatment tracking. This specificity aids in better understanding the epidemiology of candidal stomatitis and its association with immunocompromised states.

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, especially in immunocompromised patients.