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B37.0
ICD-10-CM
Oropharyngeal Candidiasis

Find information on oropharyngeal candidiasis diagnosis, including clinical documentation, ICD-10 codes (B37.0), SNOMED CT concepts, and healthcare best practices. Learn about oral thrush symptoms, treatment, and differential diagnosis for accurate medical coding and improved patient care. This resource provides guidance for clinicians on documenting oropharyngeal candidiasis in medical records and understanding associated medical terminology.

Also known as

Oral Thrush
Candidal Stomatitis

Diagnosis Snapshot

Key Facts
  • Definition : Fungal infection of the mouth and throat caused by Candida species, commonly Candida albicans.
  • Clinical Signs : White patches on tongue, inner cheeks, and throat. May cause pain, difficulty swallowing, and taste changes.
  • Common Settings : Infants, denture wearers, people with weakened immune systems, uncontrolled diabetes, or antibiotic use.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC B37.0 Coding
B37.0

Candidiasis of mouth

Fungal infection of the mouth caused by Candida species.

B37.89

Other candidiasis

Candidiasis affecting sites not specifically classified elsewhere.

B37.9

Candidiasis, unspecified

Candidiasis without further specification of location or type.

K14.0

Diseases of lips

Includes various lip disorders, sometimes a site of oral candidiasis spread.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the candidiasis confirmed or suspected?

  • Confirmed

    Pseudomembranous?

  • Suspected

    Code B37.9

Code Comparison

Related Codes Comparison

When to use each related code

Description
Oral thrush
Leukoplakia
Oral lichen planus

Documentation Best Practices

Documentation Checklist
  • Document white plaques on tongue, palate, or oropharynx.
  • Record patient's complaint of oral burning/soreness.
  • Note any immunosuppression (HIV, diabetes, etc.).
  • Describe lesion appearance (e.g., creamy, cottage cheese-like).
  • Confirm diagnosis with KOH prep or culture if needed.

Coding and Audit Risks

Common Risks
  • Unspecified Candidiasis

    Coding B37.9 (Candidiasis, unspecified) when clinical documentation supports oropharyngeal location. Impacts reimbursement and quality metrics.

  • Comorbidity Omission

    Failing to code underlying conditions like HIV or diabetes that contribute to oropharyngeal candidiasis. Affects risk adjustment.

  • Incorrect Laterality

    Coding for bilateral involvement when only unilateral is documented, or vice versa. Leads to inaccurate clinical data reporting.

Mitigation Tips

Best Practices
  • Document white plaques, location, and easy removal for ICD-10 B37.0 accuracy.
  • Include KOH microscopy or culture results for candidiasis confirmation in CDI queries.
  • Screen immunocompromised patients regularly for early diagnosis, improving HCC compliance.
  • Differentiate from leukoplakia and other oral lesions with clear clinical descriptions for coding.
  • Consider antifungal susceptibility testing for recurrent infections to guide treatment and optimize coding.

Clinical Decision Support

Checklist
  • White, creamy plaques on oral mucosa?
  • Easily scraped off, revealing erythema?
  • Patient immunocompromised (e.g., HIV, diabetes)?
  • Burning or painful sensation reported?
  • Consider differential diagnosis (e.g., leukoplakia)

Reimbursement and Quality Metrics

Impact Summary
  • Oropharyngeal Candidiasis reimbursement hinges on accurate ICD-10 B37.0 coding and supporting documentation for optimal payment.
  • Quality metrics impacted: Oral health assessment, infection control adherence. Affects hospital value-based purchasing.
  • Candidiasis treatment cost reporting influences resource allocation and benchmarks against national healthcare data.
  • Coding variations (B37.8 vs B37.0) can lead to claim denials, impacting revenue cycle and hospital reimbursement.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code B37.0 for oral thrush
  • Include anatomical site
  • Document confirming diagnostic method
  • Consider underlying conditions, code appropriately
  • Specify if acute/chronic, pseudomembranous

Documentation Templates

Patient presents with complaints consistent with oropharyngeal candidiasis, also known as oral thrush.  Symptoms include white patches on the tongue, inner cheeks, and sometimes the roof of the mouth, gums, and tonsils.  The patient may report pain, a burning sensation, or difficulty swallowing.  Lesions are described as creamy white plaques that can be scraped off, revealing erythematous mucosa.  Differential diagnosis includes leukoplakia, hairy leukoplakia, and other oral infections.  Diagnosis confirmed via clinical examination and, if necessary, microscopic examination with potassium hydroxide preparation revealing pseudohyphae and yeast cells.  Risk factors assessed included recent antibiotic use, corticosteroid use, inhaled corticosteroid use, denture use, diabetes mellitus, immunosuppression, HIV infection, and xerostomia.  The patient's current medications were reviewed.  Treatment plan includes antifungal medication such as nystatin oral suspension, clotrimazole troches, or fluconazole tablets.  Patient education provided regarding proper oral hygiene, medication administration, and follow-up care.  ICD-10 code B37.0, Oral Candidiasis, is documented.  The patient will be scheduled for a follow-up appointment to assess treatment response and resolution of symptoms.  Continued monitoring and management may be necessary for recurrent or persistent infections.
Oropharyngeal Candidiasis - AI-Powered ICD-10 Documentation