ICD-10 Code B37.41 | Candidal cystitis and urethritis Symptoms, Diagnosis, Billing

Candidal cystitis and urethritis is a fungal infection caused by Candida species, primarily affecting the bladder and urethra. This condition is clinically significant as it can lead to urinary symptoms such as dysuria, frequency, and urgency. Accurate coding with ICD-10 Code B37.41 is essential for proper diagnosis, documentation, medical billing, and public health reporting, ensuring that healthcare providers can effectively manage and treat this infection.

What is ICD-10 Code B37.41 for Candidal cystitis and urethritis?

ICD-10 Code B37.41 specifically denotes candidal cystitis and urethritis, which are infections of the bladder and urethra caused by Candida species. This code should be utilized in clinical documentation and billing when a patient presents with symptoms indicative of a Candida infection in the urinary tract, ensuring accurate representation of the patient's condition for treatment and reimbursement purposes.

ICD-10 Code B37.41 – Clinical Definition and Explanation of Candidal cystitis and urethritis

Candidal cystitis and urethritis is primarily caused by an overgrowth of Candida species, often due to factors such as antibiotic use, immunosuppression, or diabetes. The condition can progress to more severe urinary tract infections if left untreated, necessitating prompt medical attention.

Key Clinical Features:

• Dysuria (painful urination)
• Increased urinary frequency and urgency
• Possible hematuria (blood in urine)
• Foul-smelling urine
• History of recurrent urinary tract infections or antibiotic use

ICD-10 Code B37.41 for Candidal cystitis and urethritis – SOAP Notes & Clinical Use

ICD-10 Code B37.41 is utilized in SOAP notes to document the patient's symptoms, assessment findings, and treatment plans related to candidal cystitis and urethritis. This code is relevant in both acute and chronic care settings, facilitating comprehensive patient management.

What Does ICD-10 Code B37.41 for Candidal cystitis and urethritis Mean in SOAP Notes?

In SOAP notes, ICD-10 Code B37.41 connects subjective patient-reported symptoms and objective clinical findings to a formal diagnosis of candidal cystitis and urethritis. This ensures continuity of care, supports accurate billing, and meets EHR documentation standards.

Treatment Options for ICD-10 Code B37.41 – Candidal cystitis and urethritis

Candidal cystitis and urethritis requires prompt treatment to prevent complications. Antifungal therapy is the primary treatment approach.

Antibiotic Therapy:

• Fluconazole 150 mg orally once, may repeat after 72 hours if symptoms persist
• Itraconazole 200 mg orally daily for 3 days
• Voriconazole as an alternative in resistant cases

Supportive Care:

• Increased fluid intake to promote urination
• Pain management with analgesics as needed
• Avoidance of irritants such as caffeine and alcohol

Infection Control:

• Educate patients on hygiene practices to prevent recurrence
• Monitor for signs of systemic infection in immunocompromised patients
• Implement isolation precautions if necessary during outbreaks

How to Document Symptoms of Candidal cystitis and urethritis (ICD-10 B37.41) in SOAP Notes

Subjective:

• Patient reports burning sensation during urination
• Increased frequency of urination noted over the past week
• History of recent antibiotic use for a different infection
• Patient describes foul-smelling urine

Objective:

• Vital signs stable; no fever observed
• Urinalysis shows presence of yeast and white blood cells
• Physical examination reveals suprapubic tenderness
• No signs of systemic infection noted

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SOAP Note Guidelines for Diagnosing Candidal cystitis and urethritis (ICD-10 Code B37.41)

Assessment:

• Diagnosis: Candidal cystitis and urethritis, mild severity
• ICD-10 Code: B37.41
• Contributing factors: Recent antibiotic therapy, possible immunosuppression
• No signs of systemic infection at this time

Plan:

• Initiate antifungal therapy with fluconazole 150 mg orally
• Educate patient on hydration and symptom management
• Schedule follow-up appointment in one week to reassess symptoms
• Consider referral to urology if symptoms persist

Treatment & Plan Section for ICD-10 Code B37.41 – Candidal cystitis and urethritis

• First-line treatment with fluconazole or itraconazole
• Encourage lifestyle modifications to reduce recurrence risk
• Monitor symptoms and adjust treatment as necessary
• Follow-up appointments to ensure resolution of infection

Using ICD-10 Code B37.41 for Candidal cystitis and urethritis in Billing & SOAP Note Compliance

• Ensure accurate documentation of symptoms and treatment in SOAP notes
• Use B37.41 in settings such as outpatient clinics and emergency departments
• Link subjective and objective findings to support the diagnosis
• Align treatment plans with clinical guidelines for justified billing

Related ICD-10 Codes Often Used with Candidal cystitis and urethritis

• B37.49 – Other candidal infections of the urinary tract
• B37.3 – Candidiasis of the skin

ICD-10 Code B37.41 in Medical Billing and Insurance for Candidal cystitis and urethritis

ICD-10 Code B37.41 is critical in medical billing, particularly in hospital, ER, or infectious disease care settings.

Billing Notes:

• Document all relevant patient history and symptoms to support the claim.
• Use B37.41 in conjunction with other codes for comprehensive billing.
• Ensure that the diagnosis aligns with the treatment provided for reimbursement.
• Include laboratory results that confirm the diagnosis in the medical record.

Common CPT Pairings: