ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 B51.0

Billable / Specific CC

Plasmodium vivax malaria with rupture of spleen

B51
Block
0
Synonyms
129
LCDs
4
Payer Policies
14
Linked CPTs

About ICD-10-CM B51.0

ICD-10-CM code B51.0 represents Plasmodium vivax malaria with rupture of spleen. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block B51). The 2026 edition of ICD-10-CM B51.0 became effective on October 1, 2025.

Coding Tips for B51.0

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: CC

B51.0 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Inpatient DRG Impact, CC

codes Plasmodium vivax malaria with rupture of spleen. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for B51.0

Local Coverage Determinations (LCDs) from CMS MACs that list B51.0 as a covered diagnosis.

129 LCDs

Showing top 10 of 129 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81227 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81328 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81335 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 0071U →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81383 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81418 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 0073U →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81283 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81408 →
CMS LCD: Billing and Coding: Pharmacogenomics Testing
Article ID: 58801, Effective: 2026-01-01 00:00:00, 578 covered, 0 non-covered
CPT 81355 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing B51.0.

4 policies

1 Cigna

Neuropsychological Testing - (EN0258)
Policy ID: EN_MM_0258

3 Medicare

Billing and Coding: Pharmacogenomics Testing
Policy ID: ART-58801
Billing and Coding: Pharmacogenomics Testing
Policy ID: ART-58812
Billing and Coding: Pharmacogenomic Testing
Policy ID: ART-59915

CPT Codes Commonly Billed with B51.0

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

14 linkages
  • 0031U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0173U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0423U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 81407 CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0349U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 81408 CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0175U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0032U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 81220 CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD
  • 0392U CMS LCD: Billing and Coding: Pharmacogenomics Testing CMS LCD

Convert B51.0 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
B51.0 0849 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 B51.0, Billing FAQ

Is ICD-10 code B51.0 billable? +

Yes, B51.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Is B51.0 a CC or MCC for inpatient DRG? +

Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What CPT codes are commonly billed with B51.0? +

Procedures frequently paired with B51.0 include: 0031U, 0173U, 0423U, 81407, 0349U.

What ICD-9 codes does B51.0 map to? +

Per CMS GEMs, B51.0 maps to ICD-9 codes: 0849. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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