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v1.0.0
ICD-10 Guide
ICD-10 CodesB53.1

B53.1

Plasmodium falciparum malaria

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

Code Description

ICD-10 B53.1 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 (ACTs) being the first-line treatment. However, resistance to antimalarial drugs, particularly in certain regions, poses a significant challenge in managing the disease. Prophylaxis is recommended for travelers to endemic areas, utilizing medications such as atovaquone-proguanil, doxycycline, or mefloquine, depending on the region and individual patient factors. Understanding the epidemiology, clinical presentation, and treatment options for Plasmodium falciparum malaria is crucial for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between malaria species for accurate coding
  • Understanding antimalarial resistance patterns
  • Documenting travel history and exposure risk
  • Recognizing complications associated with severe malaria

Audit Risk Factors

  • Inadequate documentation of travel history
  • Failure to specify the severity of the malaria infection
  • Misidentification of malaria species
  • Lack of documentation regarding antimalarial treatment

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, including travel and exposure risks, laboratory results confirming diagnosis, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the severity of the disease and any complications for accurate coding.

Travel Medicine

Documentation Requirements

Patient travel history, prophylaxis recommendations, and any post-travel symptoms.

Common Clinical Scenarios

Pre-travel consultations for malaria prophylaxis, post-travel evaluations for symptomatic patients.

Billing Considerations

Documenting the specific regions visited and adherence to prophylaxis guidelines is crucial.

Coding Guidelines

Inclusion Criteria

Use B53.1 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, including the species of malaria and any complications

Exclusion Criteria

Do NOT use B53.1 When
  • Exclude codes for other types of malaria unless specified

Related CPT Codes

87430CPT Code

Malaria antigen detection test

Clinical Scenario

Used in conjunction with B53.1 for diagnosis confirmation.

Documentation Requirements

Document the reason for the test and results.

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 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 and helps reduce the risk of resistance.