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v1.0.0
ICD-10 Guide
ICD-10 CodesP37.4

P37.4

Billable

Other congenital malaria

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P37.4 is a billable code used to indicate a diagnosis of other congenital malaria.

Key Diagnostic Point:

Congenital malaria is a rare but serious condition resulting from the transmission of malaria parasites from an infected mother to her fetus during pregnancy. This condition can lead to severe complications in newborns, including low birth weight, anemia, and respiratory distress. The most common malaria parasite involved is Plasmodium falciparum, but other species can also be implicated. Newborns may present with symptoms such as fever, jaundice, and splenomegaly shortly after birth. Diagnosis is typically made through blood smears or rapid diagnostic tests. Treatment involves antimalarial medications, and early intervention is crucial to prevent long-term sequelae. Other congenital infectious diseases, such as congenital tuberculosis and toxoplasmosis, can present similarly, necessitating careful differential diagnosis. Congenital tuberculosis may lead to respiratory issues and systemic infection, while toxoplasmosis can cause neurological deficits and ocular problems. Understanding the clinical presentation and management of these conditions is essential for effective neonatal care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital malaria and other congenital infections.
  • Understanding the maternal history of malaria and its implications.
  • Recognizing the varied clinical presentations in neonates.
  • Navigating the treatment protocols and their documentation requirements.

Audit Risk Factors

  • Inadequate documentation of maternal malaria history.
  • Failure to document clinical signs and symptoms in the newborn.
  • Misclassification of congenital malaria with other infections.
  • Lack of follow-up documentation on treatment outcomes.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed documentation of clinical findings, maternal history, and treatment protocols.

Common Clinical Scenarios

Newborns presenting with fever and jaundice in the NICU.

Billing Considerations

Close monitoring for complications such as anemia and respiratory distress.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including developmental milestones and follow-up care.

Common Clinical Scenarios

Pediatric follow-up for infants diagnosed with congenital malaria.

Billing Considerations

Awareness of potential long-term effects on growth and development.

Coding Guidelines

Inclusion Criteria

Use P37.4 When
  • Follow ICD
  • 10 guidelines for coding congenital conditions, ensuring accurate documentation of maternal infections and neonatal symptoms
  • Use additional codes for any complications arising from congenital malaria

Exclusion Criteria

Do NOT use P37.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36415CPT Code

Collection of venous blood by venipuncture

Clinical Scenario

Used for blood tests to confirm congenital malaria diagnosis.

Documentation Requirements

Document the reason for blood draw and any relevant clinical findings.

Specialty Considerations

Neonatologists should ensure accurate lab results are linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital malaria, improving the accuracy of data collection and reimbursement processes. It emphasizes the importance of detailed documentation in maternal and neonatal health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malaria, improving the accuracy of data collection and reimbursement processes. It emphasizes the importance of detailed documentation in maternal and neonatal health.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the importance of detailed documentation in maternal and neonatal health.

Resources

Clinical References

  • •
    CDC Malaria in Pregnancy

Coding & Billing References

  • •
    CDC Malaria in Pregnancy

Frequently Asked Questions

What are the common symptoms of congenital malaria in newborns?

Common symptoms include fever, jaundice, anemia, and splenomegaly. Early recognition and treatment are crucial to prevent complications.