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ICD-10 Guide
ICD-10 CodesB54

B54

Unspecified malaria

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

Code Description

ICD-10 B54 is a billable code used to indicate a diagnosis of unspecified malaria.

Key Diagnostic Point:

Unspecified malaria refers to a diagnosis of malaria where the specific species of the Plasmodium parasite causing the infection is not identified. Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes. The disease is characterized by recurrent episodes of fever, chills, and flu-like symptoms. The most common species of Plasmodium that cause malaria in humans include Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. However, in cases where laboratory tests do not specify the species, the diagnosis falls under the unspecified category. This can occur due to limitations in testing methods or when patients present with atypical symptoms. Antimalarial resistance is a growing concern, particularly with P. falciparum, which has shown resistance to commonly used medications. Prophylaxis is crucial for travelers to endemic areas and includes medications such as atovaquone-proguanil, doxycycline, or mefloquine. Understanding the nuances of malaria diagnosis and treatment is essential for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in species identification due to laboratory limitations.
  • Differentiation between malaria types and their clinical presentations.
  • Antimalarial resistance complicating treatment protocols.
  • Prophylaxis recommendations vary based on geographic location.

Audit Risk Factors

  • Inadequate documentation of travel history.
  • Failure to specify symptoms or laboratory findings.
  • Misclassification of malaria species.
  • Inconsistent use of prophylaxis documentation.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed travel history, symptomatology, and laboratory results.

Common Clinical Scenarios

Patients presenting with fever and travel history to endemic areas.

Billing Considerations

Consideration of antimalarial resistance patterns in treatment.

Primary Care

Documentation Requirements

Thorough patient history and symptom documentation.

Common Clinical Scenarios

Patients with flu-like symptoms returning from endemic regions.

Billing Considerations

Importance of timely referral to specialists for severe cases.

Coding Guidelines

Inclusion Criteria

Use B54 When
  • According to ICD
  • 10 guidelines, B54 is used when the specific species of malaria is not documented
  • Coders should ensure that the diagnosis is supported by clinical findings and laboratory results

Exclusion Criteria

Do NOT use B54 When
  • Exclusion criteria include cases where a specific species is identified

Related CPT Codes

87449CPT Code

Malaria test, rapid diagnostic test

Clinical Scenario

Used for initial diagnosis of malaria in patients with symptoms.

Documentation Requirements

Document the reason for the test and the results.

Specialty Considerations

Infectious disease specialists may require additional lab 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 cases, improving data accuracy and treatment tracking. However, the use of unspecified codes like B54 can lead to challenges in understanding the epidemiology of malaria and may affect resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malaria cases, improving data accuracy and treatment tracking. However, the use of unspecified codes like B54 can lead to challenges in understanding the epidemiology of malaria and may affect resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malaria cases, improving data accuracy and treatment tracking. However, the use of unspecified codes like B54 can lead to challenges in understanding the epidemiology of malaria and may affect resource allocation.

Resources

Clinical References

  • •
    CDC Malaria Information

Coding & Billing References

  • •
    CDC Malaria Information

Frequently Asked Questions

When should I use code B54?

Use code B54 when a patient is diagnosed with malaria but the specific species is not identified in the documentation. Ensure that there is sufficient clinical evidence to support the diagnosis.