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v1.0.0
ICD-10 Guide
ICD-10 CodesB52.0

B52.0

Plasmodium falciparum malaria

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

Code Description

ICD-10 B52.0 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 known for its ability to cause severe illness and complications, including cerebral malaria, anemia, and multi-organ failure. Symptoms typically appear 9-14 days after infection and include fever, chills, headache, nausea, vomiting, and fatigue. Diagnosis is confirmed through blood tests that identify the presence of the parasite. Treatment involves the use of antimalarial medications, with artemisinin-based combination therapies (ACTs) being the first-line treatment. However, resistance to antimalarial drugs, particularly in certain regions, poses a significant challenge in managing this disease. Prophylaxis is recommended for travelers to endemic areas, utilizing medications such as atovaquone-proguanil, doxycycline, or mefloquine to prevent infection. Understanding the epidemiology, species identification, and resistance patterns is crucial for effective management and prevention of Plasmodium falciparum malaria.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between malaria species for accurate coding
  • Understanding the nuances of antimalarial resistance
  • Prophylaxis documentation requirements
  • Variability in clinical presentation and severity

Audit Risk Factors

  • Inadequate documentation of species identification
  • Failure to document resistance patterns
  • Lack of clarity in treatment protocols
  • Insufficient details on prophylaxis measures

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, travel history, laboratory results confirming species, and treatment plans.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas, severe malaria cases requiring hospitalization.

Billing Considerations

Ensure accurate documentation of symptoms and laboratory findings to support coding.

Travel Medicine

Documentation Requirements

Documentation of prophylaxis measures taken, patient education on malaria risks, and follow-up care.

Common Clinical Scenarios

Travelers returning from endemic regions with symptoms, pre-travel consultations for prophylaxis.

Billing Considerations

Focus on preventive measures and patient education to ensure proper coding.

Coding Guidelines

Inclusion Criteria

Use B52.0 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, treatment, and any complications
  • Include details on species identification and resistance patterns where applicable

Exclusion Criteria

Do NOT use B52.0 When
No specific exclusions found.

Related CPT Codes

87430CPT Code

Malaria antigen detection test

Clinical Scenario

Used when diagnosing malaria in patients presenting with fever.

Documentation Requirements

Document the reason for the test and the results.

Specialty Considerations

Infectious disease specialists should ensure comprehensive documentation 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 facilitating 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 facilitating 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 facilitating better tracking of disease patterns and treatment outcomes.

Resources

Clinical References

  • •
    CDC Malaria Information

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

What is the primary treatment for Plasmodium falciparum malaria?

The primary treatment for Plasmodium falciparum malaria is artemisinin-based combination therapy (ACT), which is effective against this species.