B37.81: Candidal esophagitis

Risk adjustment

B37.81 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 6 Opportunistic Infections0.381 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

B37.81 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
• A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
• A57414Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
• A58801Billing and Coding: Pharmacogenomics Testing