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B37.81 ICD-10-CM Code: Candidal esophagitis

B37.81 maps to CMS-HCC V28 6. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupB37.81

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Mycoses (B35-B49)

B37.81

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Candidal esophagitis

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

Buddy the Bee presenting code insight

Buddy Insight

Candidal esophagitis is a hallmark opportunistic infection strongly associated with immunocompromised states, particularly HIV/AIDS with CD4 counts below 200.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 6

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 006

Code-level coefficient reference

ESRD/PACE

HCC 6

Code-level coefficient reference

RXHCC

HCC 5

Code-level coefficient reference

Code Book Path

Official
B37CandidiasisB37.8Candidiasis of other sitesB37.81Candidal esophagitis

Inclusion Terms

Official

No inclusion terms are included in this display for B37.81. Check the code and parent instructions in the Code Book.

Excludes 2

Official
  • carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99, B35-B49
  • infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99, B35-B49
  • infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99, B35-B49
  • influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99, B35-B49
  • hypersensitivity pneumonitis due to organic dust (J67.-)Inherited from A00-B99, B35-B49
  • mycosis fungoides (C84.0-)Inherited from A00-B99, B35-B49

Related Codes

Official
B37.82Candidal enteritisB37.83Candidal cheilitisB37.84Candidal otitis externaB37.89Other sites of candidiasis

Includes

Official
  • diseases generally recognized as communicable or transmissibleInherited from A00-B99, B37
  • candidosisInherited from A00-B99, B37
  • moniliasisInherited from A00-B99, B37

Excludes 1

Official
  • certain localized infections - see body system-related chaptersInherited from A00-B99, B37
  • neonatal candidiasis (P37.5)Inherited from A00-B99, B37

Code First

Official

No Code First sequencing instructions are included in this display for B37.81. Check the code and parent instructions in the Code Book.

Use Additional

Official
  • code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99

Code Also

Official

No Code Also instructions are included in this display for B37.81. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
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

MEAT Support

HCC Buddy guidance
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

Audit Caution

HCC Buddy guidance
Failing to code the underlying immunodeficiency (B20 for HIV) alongside the opportunistic infection results in an incomplete clinical picture
Confusing oral candidiasis (thrush, B37.0) with esophageal candidiasis — endoscopy or barium swallow is needed to confirm esophageal involvement
Using unspecified candidiasis (B37.9) when the esophageal site is clearly documented in the record

Common Mistakes

HCC Buddy guidance
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

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is B37.81 an HCC code?

Yes. B37.81 (Candidal esophagitis) maps to HCC 6, Opportunistic Infections under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.381. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: B37.81 is billable and maps to V28 HCC 6, Opportunistic Infections. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
B37.81
Description
Candidal esophagitis
HCC (V28)
HCC 6 — Opportunistic Infections
RAF reference coefficient
0.381
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 6, Opportunistic Infections
0.381
ESRDHCC 6, Opportunistic Infections
Not separately weighted
RxHCCHCC 5, Opportunistic Infections
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work B37.81 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for B37.81

For B37.81, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

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What This Code Means

B37.81 is the ICD-10-CM diagnosis code for candidal esophagitis. A yeast infection of the esophagus (food pipe) that causes difficulty swallowing, pain, and discomfort. B37.81 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering mycoses (b35-b49).

Under the CMS-HCC V28 risk adjustment model, B37.81 maps to Opportunistic Infections (HCC 6) with a source-labeled community, non-dual, aged reference coefficient of 0.381. No V24 mapping is shown for B37.81; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Common in immunocompromised patients, especially those with HIV/AIDS; document immune status if available. For B37.81, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for B37.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

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.

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

Child Codes

B37.81Candidal esophagitis
HCC 6
B37.82Candidal enteritis
B37.83Candidal cheilitis
B37.84Candidal otitis externa
B37.89Other sites of candidiasis

Code Hierarchy

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

For B37.81, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

B37.81 maps to CMS-HCC V28 category 6, Opportunistic Infections. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for B37.81. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work B37.81 in HCC Buddy

Open B37.81 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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