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ICD-10 Guide
ICD-10 CodesB51.9

B51.9

Plasmodium falciparum malaria, unspecified

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

Code Description

ICD-10 B51.9 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 fatigue, which can progress to severe complications such as cerebral malaria, anemia, and multi-organ failure if not treated promptly. The unspecified designation indicates that the specific clinical manifestations or severity of the malaria infection have not been detailed. Accurate identification of the species is crucial for treatment decisions, 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.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of malaria.
  • Need for species identification to guide treatment.
  • Potential for antimalarial resistance complicating treatment choices.
  • Documentation of travel history and exposure risk.

Audit Risk Factors

  • Inadequate documentation of travel history.
  • Failure to specify the severity of the malaria infection.
  • Misidentification of the malaria species.
  • Lack of evidence for prophylaxis measures taken.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history including travel history, symptoms, and laboratory results confirming diagnosis.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas, patients with severe symptoms requiring hospitalization.

Billing Considerations

Ensure accurate species identification and documentation of any complications or co-morbidities.

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, patients seeking advice on malaria prevention.

Billing Considerations

Emphasize the importance of prophylaxis adherence and patient education on symptoms.

Coding Guidelines

Inclusion Criteria

Use B51.9 When
  • Follow the official ICD
  • CM coding guidelines for infectious diseases, ensuring accurate documentation of the patient's clinical presentation, travel history, and any laboratory findings

Exclusion Criteria

Do NOT use B51.9 When
  • Exclude codes for other types of malaria unless specified

Related CPT Codes

87430CPT Code

Malaria antigen detection test

Clinical Scenario

Used to confirm diagnosis of malaria in symptomatic patients.

Documentation Requirements

Document the reason for the test and the patient's travel history.

Specialty Considerations

Infectious disease specialists should ensure accurate interpretation of test 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 treatment tracking. B51.9 provides a means to capture cases where the species or severity is not specified, but it is essential to strive for more precise coding when possible.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malaria types, improving data accuracy and treatment tracking. B51.9 provides a means to capture cases where the species or severity is not specified, but it is essential to strive for more precise coding when possible.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malaria types, improving data accuracy and treatment tracking. B51.9 provides a means to capture cases where the species or severity is not specified, but it is essential to strive for more precise coding when possible.

Resources

Clinical References

  • •
    CDC Malaria Information

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

What is the significance of coding B51.9?

Coding B51.9 is important for tracking malaria cases and understanding the epidemiology of Plasmodium falciparum malaria. It helps in resource allocation and treatment planning, especially in endemic regions.