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ICD-10 Guide
ICD-10 CodesB43.9

B43.9

Candidiasis, unspecified

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

Code Description

ICD-10 B43.9 is a billable code used to indicate a diagnosis of candidiasis, unspecified.

Key Diagnostic Point:

Candidiasis, also known as thrush or yeast infection, is a fungal infection caused by the overgrowth of Candida species, primarily Candida albicans. This condition can affect various parts of the body, including the mouth, throat, esophagus, and genital area. In immunocompromised patients, such as those with HIV/AIDS, cancer, or those undergoing immunosuppressive therapy, the risk of developing candidiasis significantly increases. Symptoms may vary depending on the site of infection but often include itching, irritation, and discomfort. In severe cases, candidiasis can lead to systemic infections, particularly in patients with weakened immune systems. Diagnosis typically involves clinical evaluation and may be confirmed through laboratory tests, including cultures or microscopic examination of affected tissues. Treatment usually involves antifungal medications, such as fluconazole or itraconazole, which can be administered orally or intravenously, depending on the severity of the infection. It is crucial for healthcare providers to monitor patients closely, especially those who are immunocompromised, to prevent complications associated with candidiasis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation based on the site of infection.
  • Differentiation from other fungal infections.
  • Need for thorough patient history to assess immunocompromised status.
  • Potential for systemic involvement in high-risk patients.

Audit Risk Factors

  • Inadequate documentation of immunocompromised status.
  • Failure to specify the site of infection.
  • Lack of evidence for antifungal treatment.
  • Misclassification of candidiasis as a bacterial infection.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, including immunocompromised status and treatment response.

Common Clinical Scenarios

Patients presenting with recurrent candidiasis or systemic infections.

Billing Considerations

Consideration of antifungal resistance and alternative treatments.

Primary Care

Documentation Requirements

Comprehensive documentation of symptoms and treatment plans.

Common Clinical Scenarios

Patients with oral thrush or vaginal yeast infections.

Billing Considerations

Monitoring for recurrence and patient education on prevention.

Coding Guidelines

Inclusion Criteria

Use B43.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's condition, treatment, and any underlying immunocompromising factors

Exclusion Criteria

Do NOT use B43.9 When
  • Exclude codes for other specific fungal infections unless they are documented

Related CPT Codes

87591CPT Code

Infectious agent detection by nucleic acid (DNA or RNA); Candida species

Clinical Scenario

Used when laboratory confirmation of candidiasis is required.

Documentation Requirements

Document the reason for testing and any relevant clinical findings.

Specialty Considerations

Infectious disease specialists may order this test more frequently.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of candidiasis, improving the ability to track and manage this condition, especially in immunocompromised populations. It has also enhanced the granularity of data for research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of candidiasis, improving the ability to track and manage this condition, especially in immunocompromised populations. It has also enhanced the granularity of data for research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of candidiasis, improving the ability to track and manage this condition, especially in immunocompromised populations. It has also enhanced the granularity of data for research and treatment outcomes.

Resources

Clinical References

  • •
    CDC - Fungal Diseases

Coding & Billing References

  • •
    CDC - Fungal Diseases

Frequently Asked Questions

What are the common symptoms of candidiasis?

Common symptoms include itching, irritation, and discomfort in the affected area, which may vary depending on the site of infection.

How is candidiasis treated?

Candidiasis is typically treated with antifungal medications such as fluconazole or itraconazole, with the choice depending on the severity and site of infection.