Acute pulmonary histoplasmosis capsulati is a fungal infection caused by inhaling spores of the Histoplasma capsulatum fungus. This condition is clinically significant as it can lead to severe respiratory symptoms and complications, particularly in immunocompromised individuals. The ICD-10 Code B39.0 facilitates accurate diagnosis, documentation, medical billing, and public health reporting, ensuring appropriate management and resource allocation.
What is ICD-10 Code B39.0 for Acute pulmonary histoplasmosis capsulati?
ICD-10 Code B39.0 represents Acute pulmonary histoplasmosis capsulati, an infection primarily affecting the lungs due to the inhalation of Histoplasma capsulatum spores. This code should be used in clinical documentation and billing when a patient presents with respiratory symptoms linked to this fungal infection, ensuring proper identification and management of the condition.
ICD-10 Code B39.0 – Clinical Definition and Explanation of Acute pulmonary histoplasmosis capsulati
Acute pulmonary histoplasmosis capsulati is caused by the inhalation of spores from the Histoplasma capsulatum fungus, often found in soil enriched with bird or bat droppings. The condition can progress rapidly, leading to significant respiratory distress and requires prompt medical attention.
Key Clinical Features:
- Fever and chills
- Cough, often productive
- Chest pain or discomfort
- Shortness of breath
- Fatigue and malaise
ICD-10 Code B39.0 for Acute pulmonary histoplasmosis capsulati – SOAP Notes & Clinical Use
ICD-10 Code B39.0 is utilized in SOAP notes to document the patient's symptoms, assessment findings, and treatment plans related to acute pulmonary histoplasmosis capsulati. This code is relevant in both acute and chronic care settings, ensuring comprehensive patient management.
What Does ICD-10 Code B39.0 for Acute pulmonary histoplasmosis capsulati Mean in SOAP Notes?
In SOAP notes, ICD-10 Code B39.0 connects subjective patient-reported symptoms and objective clinical findings to a formal diagnosis of acute pulmonary histoplasmosis capsulati. This linkage is crucial for ensuring continuity of care, supporting accurate billing, and meeting EHR documentation standards.
Treatment Options for ICD-10 Code B39.0 – Acute pulmonary histoplasmosis capsulati
Acute pulmonary histoplasmosis capsulati may necessitate hospitalization, particularly in severe cases. Treatment typically involves antifungal therapy and supportive care.
Antibiotic Therapy:
- First-line: Itraconazole, typically for 6-12 weeks
- Alternative: Amphotericin B for severe cases, duration based on clinical response
- Consideration for chronic cases: Long-term itraconazole therapy
Supportive Care:
- Oxygen therapy for hypoxemia
- Bronchodilators for wheezing
- Fluid management and electrolyte monitoring
Infection Control:
- Isolation precautions in hospital settings during outbreaks
- Education on avoiding exposure to contaminated environments
How to Document Symptoms of Acute pulmonary histoplasmosis capsulati (ICD-10 B39.0) in SOAP Notes
Subjective:
- Patient reports persistent cough with sputum production
- History of exposure to bird droppings or bat caves
- Complaints of fever and chills over the past week
- Experiencing shortness of breath on exertion
Objective:
- Auscultation reveals crackles and wheezing
- Respiratory rate: 22 breaths per minute
- Oxygen saturation: 92% on room air
- Chest X-ray shows infiltrates consistent with fungal infection
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SOAP Note Guidelines for Diagnosing Acute pulmonary histoplasmosis capsulati (ICD-10 Code B39.0)
Assessment:
- Diagnosis: Acute pulmonary histoplasmosis capsulati, moderate severity
- ICD-10 Code: B39.0
- Contributing factors: Recent travel to endemic area, exposure to contaminated soil
- Consider differential diagnoses such as bacterial pneumonia or other fungal infections
Plan:
- Initiate antifungal therapy with itraconazole
- Provide patient education on symptom management and follow-up care
- Monitor respiratory status and oxygen levels closely
- Schedule follow-up appointment in one week to assess treatment response
Treatment & Plan Section for ICD-10 Code B39.0 – Acute pulmonary histoplasmosis capsulati
- First-line pharmacologic treatment: Itraconazole for 6-12 weeks
- Non-pharmacologic strategies: Avoidance of exposure to contaminated environments
- Monitoring practices: Regular follow-up visits to assess symptom resolution and treatment efficacy
- Patient education on recognizing worsening symptoms and when to seek immediate care
Using ICD-10 Code B39.0 for Acute pulmonary histoplasmosis capsulati in Billing & SOAP Note Compliance
- Select appropriate ICD-10 code based on clinical findings and documentation
- Ensure detailed documentation of symptoms and treatment plans to support billing
- Utilize code in both inpatient and outpatient settings for accurate reimbursement
- Align treatment plans with clinical guidelines to justify billing and coding decisions
Related ICD-10 Codes Often Used with Acute pulmonary histoplasmosis capsulati
ICD-10 Code B39.0 in Medical Billing and Insurance for Acute pulmonary histoplasmosis capsulati
ICD-10 Code B39.0 is essential for accurate billing in hospital, emergency room, or infectious disease care settings.
Billing Notes:
- Document all relevant clinical findings and treatment details to support the claim
- Use the code in conjunction with appropriate CPT codes for comprehensive billing
- Ensure that the diagnosis is clearly linked to the patient's presenting symptoms in the medical record
Common CPT Pairings:
| CPT Code | Description |
|---|---|
| 99213 | Established patient office visit, moderate complexity |
| 71045 | Chest X-ray, single view |
| 87520 | Infectious agent detection by nucleic acid (DNA or RNA), direct probe technique |
Frequently Asked Questions
Common Questions About Using ICD-10 Code B39.0 for Acute pulmonary histoplasmosis capsulati
What are the common symptoms of acute pulmonary histoplasmosis capsulati?
Common symptoms include fever, cough, chest pain, and shortness of breath. Patients may also experience fatigue and malaise, particularly in severe cases.
How is acute pulmonary histoplasmosis capsulati diagnosed?
Diagnosis typically involves clinical evaluation, patient history of exposure, and imaging studies such as chest X-rays or CT scans, along with laboratory tests to confirm the presence of Histoplasma capsulatum.
Is acute pulmonary histoplasmosis capsulati contagious?
No, acute pulmonary histoplasmosis capsulati is not contagious. It is contracted through inhalation of fungal spores from contaminated environments, not through person-to-person contact.
What is the treatment for acute pulmonary histoplasmosis capsulati?
Treatment usually involves antifungal medications such as itraconazole or amphotericin B for severe cases, along with supportive care to manage symptoms and prevent complications.
