ICD-10 Coding for Dyspnea with Exertion(R06.02)
Complete ICD-10-CM coding and documentation guide for Dyspnea with Exertion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dyspnea with Exertion
R06.00-R06.09Primary Range
Abnormalities of breathing
This range includes codes for various types of dyspnea, including exertional dyspnea.
Heart failure
Heart failure can cause dyspnea with exertion, and these codes may be primary if heart failure is the underlying cause.
Chronic obstructive pulmonary disease (COPD)
COPD can present with exertional dyspnea, and these codes are used when COPD is the primary condition.
Key Information: ICD-10 code for dyspnea with exertion
Essential facts and insights about Dyspnea with Exertion
Primary ICD-10-CM Code for dyspnea with exertion
Decision Criteria
clinical Criteria
- Presence of dyspnea specifically during exertion without acute respiratory conditions
coding Criteria
- Excludes acute respiratory failure and ARDS
Applicable To
- Exertional dyspnea
Clinical Validation Requirements
- Documented exertion level causing dyspnea
- Exclusion of acute respiratory conditions
Code-Specific Risks
- Misuse as a catch-all for any dyspnea without proper documentation
Coding Notes
- Ensure documentation specifies exertion level and excludes acute conditions.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Heart failure, unspecified
I50.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dyspnea with Exertion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R06.02.
Impact
Clinical: Inaccurate assessment of patient condition, Regulatory: Potential for audit issues, Financial: Risk of claim denials
Mitigation Strategy
Use specific descriptors for exertion levels, Document any related test results
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with Excludes1 notes., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use J80 for ARDS instead of R06.02.
Impact
Risk of coding R06.02 with excluded conditions like ARDS.
Mitigation Strategy
Regular training on Excludes1 notes and coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Dyspnea with Exertion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dyspnea with Exertion
Use these documentation templates to ensure complete and accurate documentation for Dyspnea with Exertion. These templates include all required elements for proper coding and billing.
Cardiology Clinic Visit
Specialty: CardiologyRequired Elements
- Patient history
- Exertion level causing dyspnea
- Relevant test results (e.g., BNP, Echo)
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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