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v1.0.0
ICD-10 Guide
ICD-10 CodesB53.0

B53.0

Plasmodium falciparum malaria

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

Code Description

ICD-10 B53.0 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 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 identify the presence of the parasite. Treatment involves the use of antimalarial medications, with artemisinin-based combination therapies being the first-line treatment. However, resistance to these medications has been reported in some regions, complicating treatment protocols. Prophylaxis is recommended for travelers to endemic areas, utilizing medications such as atovaquone-proguanil or mefloquine to prevent infection. Understanding the epidemiology, clinical presentation, and treatment options for Plasmodium falciparum malaria is crucial for effective management and coding.

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 for travelers.
  • Variability in clinical presentation and severity.

Audit Risk Factors

  • Inadequate documentation of travel history.
  • Failure to specify the severity of the disease.
  • Misidentification of malaria species.
  • Lack of laboratory confirmation in medical records.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed clinical notes on symptoms, travel history, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas.

Billing Considerations

Ensure accurate species identification and treatment response documentation.

Travel Medicine

Documentation Requirements

Documentation of prophylaxis measures taken and patient education provided.

Common Clinical Scenarios

Pre-travel consultations for individuals traveling to malaria-endemic regions.

Billing Considerations

Emphasize the importance of preventive measures and adherence to prophylaxis.

Coding Guidelines

Inclusion Criteria

Use B53.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, including any complications or associated conditions
  • Include laboratory confirmation and travel history where applicable

Exclusion Criteria

Do NOT use B53.0 When
No specific exclusions found.

Related CPT Codes

87430CPT Code

Malaria antigen detection test

Clinical Scenario

Used to confirm diagnosis in patients presenting with symptoms.

Documentation Requirements

Document the reason for the test and results.

Specialty Considerations

Infectious disease specialists should ensure comprehensive testing.

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

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

What is the primary treatment for Plasmodium falciparum malaria?

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