B41.0
BillablePulmonary paracoccidioidomycosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B41.0 an HCC code?
Yes. B41.0 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for B41.0
For B41.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B41.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B41.0 is the ICD-10-CM diagnosis code for pulmonary paracoccidioidomycosis. A fungal lung infection caused by Paracoccidioides, a fungus found in soil and vegetation, primarily affecting the respiratory system. B41.0 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering mycoses (b35-b49).
Under the older CMS-HCC V24 model, B41.0 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess (HCC 115) with a community, non-dual, aged base RAF weight of 0.339. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This infection is more common in Central and South America. Because B41.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for B41.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This infection is more common in Central and South America
- •Document severity and extent of pulmonary involvement when available
Clinical Significance
Pulmonary paracoccidioidomycosis is caused by Paracoccidioides brasiliensis, an endemic dimorphic fungus in Latin America. This rare diagnosis in the United States typically involves patients with travel or immigration history. It can cause progressive pulmonary fibrosis and requires long-term antifungal therapy, making accurate coding essential for resource capture.
Documentation Requirements
- ✓Positive culture, serology, or histopathologic confirmation of Paracoccidioides
- ✓Pulmonary imaging findings (bilateral interstitial infiltrates, fibrosis, cavitation)
- ✓Travel or residence history in endemic areas (Brazil, Colombia, Venezuela, Argentina)
- ✓Respiratory symptoms documented: chronic cough, dyspnea, chest pain
- ✓Duration and treatment plan for antifungal therapy
Commonly Confused Codes
- •B38.0-B38.2 (Pulmonary coccidioidomycosis) - different endemic fungus; coccidioidomycosis is southwestern US, paracoccidioidomycosis is South America
- •B39.0-B39.2 (Pulmonary histoplasmosis) - different organism; distinction requires culture or serologic confirmation
- •B41.7 (Disseminated paracoccidioidomycosis) - use when infection has spread beyond the lungs to other organs