ICD-10 Guide

B42.0

Pulmonary coccidioidomycosis

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/05/2025

Code Description

ICD-10 B42.0 is a billable code used to indicate a diagnosis of pulmonary coccidioidomycosis.

Key Diagnostic Point:

Pulmonary coccidioidomycosis is a fungal infection caused by the inhalation of spores from the Coccidioides species, primarily C. immitis and C. posadasii. This condition is endemic to certain regions, particularly the southwestern United States, parts of Mexico, and Central and South America. The infection can manifest as a mild respiratory illness, often resembling influenza, but can progress to more severe pulmonary disease, especially in immunocompromised individuals. Symptoms may include cough, fever, chest pain, and fatigue. In some cases, the infection can disseminate beyond the lungs, leading to more serious complications. Diagnosis is typically confirmed through serological tests, culture, or histopathological examination. Treatment often involves antifungal medications such as fluconazole or itraconazole, particularly in cases of severe or disseminated disease. Early recognition and appropriate management are crucial to prevent complications, especially in patients with weakened immune systems, such as those with HIV/AIDS, cancer, or those on immunosuppressive therapies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Differentiating between pulmonary and disseminated forms of coccidioidomycosis.
Need for accurate documentation of patient immunocompromised status.
Variability in clinical presentation and symptomatology.
Potential for co-infection with other pathogens.

Audit Risk Factors

Inadequate documentation of the patient's immunocompromised status.
Failure to document the severity of the infection.
Misclassification of pulmonary versus disseminated disease.
Lack of supporting lab results in the medical record.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and treatment plans.

Common Clinical Scenarios

Patients presenting with respiratory symptoms in endemic areas, immunocompromised patients with suspected fungal infections.

Billing Considerations

Ensure thorough documentation of travel history and exposure to endemic areas.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging studies, and treatment response documentation.

Common Clinical Scenarios

Patients with chronic cough, pneumonia-like symptoms, or abnormal chest imaging.

Billing Considerations

Document any comorbid pulmonary conditions that may complicate the diagnosis.

Coding Guidelines

Inclusion Criteria

Use B42.0 When

Follow the official ICD
CM coding guidelines, ensuring that the code is used only when there is a confirmed diagnosis of pulmonary coccidioidomycosis

Exclusion Criteria

Do NOT use B42.0 When

Exclude cases where the infection is not confirmed or where the patient has a different fungal infection

Related CPT Codes

87481CPT Code

Coccidioides antibody test

Clinical Scenario

Used to confirm diagnosis in patients with suspected coccidioidomycosis.

Documentation Requirements

Document the reason for testing and the results.

Specialty Considerations

Infectious disease specialists should ensure that all relevant lab results are included in the patient's record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fungal infections, including pulmonary coccidioidomycosis, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fungal infections, including pulmonary coccidioidomycosis, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fungal infections, including pulmonary coccidioidomycosis, which enhances data accuracy and improves patient care tracking.

Resources

Clinical References

•
CDC Coccidioidomycosis Information

Coding & Billing References

•
CDC Coccidioidomycosis Information

Frequently Asked Questions

What are the common symptoms of pulmonary coccidioidomycosis?

Common symptoms include cough, fever, chest pain, and fatigue. Some patients may experience more severe respiratory distress.

ICD-10 B42.0 is a billable code used to indicate a diagnosis of pulmonary coccidioidomycosis.