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ICD-10 Guide
ICD-10 CodesB52

B52

Plasmodium falciparum malaria

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

Code Description

ICD-10 B52 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. 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 being the first-line treatment. However, resistance to antimalarial drugs, particularly artemisinin, has been reported in some regions, complicating treatment protocols. Prophylaxis is recommended for travelers to endemic areas and includes medications such as atovaquone-proguanil, doxycycline, or mefloquine, depending on the region and individual patient factors. Continuous monitoring of drug resistance patterns is essential for effective management and prevention of this life-threatening disease.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the disease.
  • Need for species identification to determine appropriate treatment.
  • Emerging antimalarial resistance complicating treatment protocols.
  • Prophylaxis recommendations vary based on geographic location.

Audit Risk Factors

  • Inadequate documentation of travel history.
  • Failure to specify the severity of the disease.
  • Lack of evidence for species identification.
  • Improper coding of related complications.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed travel history, clinical symptoms, and laboratory results confirming diagnosis.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas.

Billing Considerations

Consideration of co-infections and resistance patterns in treatment.

Travel Medicine

Documentation Requirements

Pre-travel consultation notes, prophylaxis prescriptions, and post-travel follow-up.

Common Clinical Scenarios

Travelers returning with febrile illness from endemic regions.

Billing Considerations

Emphasis on preventive measures and education on malaria risks.

Coding Guidelines

Inclusion Criteria

Use B52 When
  • Follow the official ICD
  • CM coding guidelines for infectious diseases
  • Ensure accurate documentation of the species and severity of malaria
  • Include any relevant complications or co
  • morbidities

Exclusion Criteria

Do NOT use B52 When
No specific exclusions found.

Related Codes

Child Codes

3 codes
B52.0
Plasmodium falciparum malaria
B52.8
Toxoplasmosis due to other specified organisms
B52.9
Plasmodium falciparum malaria, unspecified

Related CPT Codes

87430CPT Code

Malaria antigen detection test

Clinical Scenario

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

Documentation Requirements

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

Specialty Considerations

Infectious disease specialists should ensure proper 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 enabling 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 enabling 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 enabling better tracking of disease patterns and treatment outcomes.

Resources

Clinical References

  • •
    CDC Malaria Information
  • •
    WHO Malaria Fact Sheet

Coding & Billing References

  • •
    CDC Malaria Information
  • •
    WHO Malaria Fact Sheet

Frequently Asked Questions

What are the common symptoms of Plasmodium falciparum malaria?

Common symptoms include fever, chills, headache, nausea, vomiting, and muscle pain. Severe cases may present with neurological symptoms, respiratory distress, or multi-organ failure.

How is Plasmodium falciparum malaria diagnosed?

Diagnosis is typically made through blood smears or rapid diagnostic tests that detect specific antigens associated with the Plasmodium falciparum parasite.

What are the recommended prophylactic measures for travelers?

Prophylactic measures include medications such as atovaquone-proguanil, doxycycline, or mefloquine, depending on the traveler's destination and individual health factors.