B37.81

Billable

Candidal esophagitis

HCC Category Mapping

V28HCC 6 — Opportunistic Infections

0.439

V24HCC 6 — Opportunistic Infections

0.440

ESRDHCC 6 — Opportunistic Infections

0.000

RxHCCHCC 5 — Opportunistic Infections

0.000

What This Code Means

A yeast infection of the esophagus (food pipe) that causes difficulty swallowing, pain, and discomfort.

Coding Tips

•Common in immunocompromised patients, especially those with HIV/AIDS; document immune status if available
•Endoscopy findings typically confirm diagnosis; verify documentation mentions esophageal involvement specifically

Clinical Significance

Candidal esophagitis is a hallmark opportunistic infection strongly associated with immunocompromised states, particularly HIV/AIDS with CD4 counts below 200. Its presence signals significant immune dysfunction and carries a high RAF weight, making accurate capture essential for reflecting true patient acuity in risk adjustment models.

Documentation Requirements

✓Endoscopy findings confirming esophageal candidiasis (white plaques, mucosal erythema)
✓Culture or histopathologic confirmation of Candida species when available
✓Underlying immunocompromised condition documented (HIV status, CD4 count, transplant, chemotherapy)
✓Symptoms documented: dysphagia, odynophagia, retrosternal pain
✓Current and prior antifungal treatment regimen

Commonly Confused Codes

B37.0 (Candidal stomatitis) - oral thrush affecting the mouth only, not the esophagus; esophageal involvement requires B37.81 K20.9 (Esophagitis, unspecified) - non-infectious esophagitis; if Candida is the cause, use B37.81 instead B37.89 (Other sites of candidiasis) - use only when candidiasis affects sites other than esophagus, mouth, or other specified locations

Code Hierarchy

└B37Candidiasis └B37.8Candidiasis of other sites └B37.81Candidal esophagitis

└B37.81Candidal esophagitis