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v1.0.0
ICD-10 Guide
ICD-10 CodesB52.9

B52.9

Plasmodium falciparum malaria, unspecified

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

Code Description

ICD-10 B52.9 is a billable code used to indicate a diagnosis of plasmodium falciparum malaria, unspecified.

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. Symptoms typically include fever, chills, headache, nausea, vomiting, and muscle pain. In severe cases, it can lead to complications such as cerebral malaria, anemia, and multi-organ failure. The unspecified designation indicates that the specific clinical manifestations or severity of the malaria infection have not been documented. Accurate identification of the species is crucial for treatment, as Plasmodium falciparum is known for its potential resistance to common antimalarial medications, necessitating careful selection of therapeutic agents. Prophylaxis is recommended for travelers to endemic areas, with medications such as atovaquone-proguanil, doxycycline, or mefloquine being commonly prescribed to prevent infection. Understanding the epidemiology, clinical presentation, and treatment options for Plasmodium falciparum malaria is essential for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of clinical presentations and severity levels
  • Potential for co-infections with other malaria species
  • Need for species identification for accurate treatment
  • Antimalarial resistance patterns

Audit Risk Factors

  • Inadequate documentation of symptoms and severity
  • Failure to specify travel history or exposure risk
  • Misidentification of malaria species
  • Inconsistent use of prophylaxis documentation

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, travel history, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas.

Billing Considerations

Ensure accurate species identification and document any resistance patterns.

Travel Medicine

Documentation Requirements

Documentation of pre-travel consultations, prophylaxis prescribed, and post-travel evaluations.

Common Clinical Scenarios

Travelers returning from endemic regions with febrile illness.

Billing Considerations

Emphasize the importance of prophylaxis adherence and education on symptoms.

Coding Guidelines

Inclusion Criteria

Use B52.9 When
  • Follow ICD
  • CM guidelines for coding infectious diseases, ensuring that all relevant clinical details are documented
  • Include any relevant travel history and laboratory results to support the diagnosis

Exclusion Criteria

Do NOT use B52.9 When
No specific exclusions found.

Related CPT Codes

87449CPT Code

Malaria antigen detection

Clinical Scenario

Used for rapid diagnosis of malaria in patients presenting with fever.

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 cases, improving data accuracy and facilitating better tracking of malaria epidemiology and treatment outcomes.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    CDC Malaria Information

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

What is the significance of specifying the malaria species?

Specifying the malaria species is crucial for determining the appropriate treatment and understanding the potential for complications and drug resistance.