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v1.0.0
ICD-10 Guide
ICD-10 CodesB51.0

B51.0

Plasmodium falciparum malaria

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

Code Description

ICD-10 B51.0 is a billable code used to indicate a diagnosis of plasmodium falciparum malaria.

Key Diagnostic Point:

Plasmodium falciparum malaria is a severe form of malaria caused by the Plasmodium falciparum parasite, which is transmitted to humans through the bite of infected Anopheles mosquitoes. This species is responsible for the majority of malaria-related morbidity and mortality worldwide, particularly in sub-Saharan Africa. Clinical manifestations can range from mild flu-like symptoms to severe complications such as cerebral malaria, acute respiratory distress syndrome, and multi-organ failure. Diagnosis is typically confirmed through blood smears or rapid diagnostic tests that detect specific antigens. Treatment involves the use of antimalarial medications, with artemisinin-based combination therapies (ACTs) being the first-line treatment. However, resistance to antimalarial drugs, particularly artemisinin, has been reported in some regions, complicating treatment strategies. Prophylaxis is recommended for travelers to endemic areas, utilizing medications such as atovaquone-proguanil or mefloquine, along with preventive measures like insect repellent and bed nets.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between malaria species for accurate coding.
  • Understanding the nuances of antimalarial resistance.
  • Prophylaxis documentation requirements.
  • Variability in clinical presentation and severity.

Audit Risk Factors

  • Inadequate documentation of species identification.
  • Failure to document treatment response or complications.
  • Misclassification of malaria type.
  • Lack of travel history in patients with malaria.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed travel history, laboratory results, and treatment plans.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas.

Billing Considerations

Need for accurate species identification and awareness of local resistance patterns.

Travel Medicine

Documentation Requirements

Prophylaxis prescriptions, patient education on prevention.

Common Clinical Scenarios

Pre-travel consultations for individuals traveling to malaria-endemic regions.

Billing Considerations

Emphasis on preventive measures and understanding of local malaria transmission dynamics.

Coding Guidelines

Inclusion Criteria

Use B51.0 When
  • Follow the official ICD
  • CM coding guidelines for infectious diseases
  • Ensure accurate documentation of the species and any complications

Exclusion Criteria

Do NOT use B51.0 When
  • Exclude codes for other types of malaria unless specified

Related CPT Codes

87430CPT Code

Malaria antigen detection

Clinical Scenario

Used when testing for malaria in symptomatic patients.

Documentation Requirements

Document the reason for testing and results.

Specialty Considerations

Infectious disease specialists should ensure accurate interpretation of results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malaria types, improving data accuracy and facilitating better tracking of disease patterns and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malaria types, improving data accuracy and facilitating better tracking of disease patterns and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malaria types, improving data accuracy and facilitating better tracking of disease patterns and treatment outcomes.

Resources

Clinical References

  • •
    CDC Malaria Information

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

What is the primary treatment for Plasmodium falciparum malaria?

The primary treatment for Plasmodium falciparum malaria is artemisinin-based combination therapy (ACT), which is effective against this species and helps reduce the risk of resistance.