ICD-10 Coding for Peripheral Edema(R60.0, R60.1, I87.1)
Complete ICD-10-CM coding and documentation guide for Peripheral Edema. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Peripheral Edema
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R60.0 | Localized edema | Use when edema is confined to a specific area and not due to systemic conditions. |
|
| R60.1 | Generalized edema | Use when edema affects multiple body regions. |
|
| I87.1 | Chronic venous hypertension (idiopathic) with inflammation | Use when edema is due to chronic venous insufficiency. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for peripheral edema
Essential facts and insights about Peripheral Edema
Primary ICD-10-CM Codes for peripheral edema
Decision Criteria
clinical Criteria
- Edema confined to a specific area without systemic cause
Applicable To
- Swelling in specific areas without systemic cause
Excludes
- Generalized edema (R60.1)
Clinical Validation Requirements
- Physical exam showing pitting in a localized area
- Absence of systemic causes like heart failure
Code-Specific Risks
- Incorrectly using for generalized edema
Coding Notes
- Ensure documentation specifies the location and extent of edema.
R60.1 - Generalized edema
Use when edema affects multiple body regions.
Applicable To
- Anasarca
Excludes
- Localized edema (R60.0)
Clinical Validation Requirements
- Physical exam showing widespread edema
- Lab tests indicating systemic fluid retention
Coding Notes
Document the extent and systemic nature of edema.
I87.1 - Chronic venous hypertension (idiopathic) with inflammation
Use when edema is due to chronic venous insufficiency.
Applicable To
- Venous stasis ulcers
Excludes
- Acute venous embolism and thrombosis (I82.-)
Clinical Validation Requirements
- Venous duplex ultrasound showing venous insufficiency
- Presence of hemosiderin deposits or venous ulcers
Coding Notes
Ensure documentation includes venous insufficiency findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Peripheral Edema to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R60.0.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document the suspected or confirmed cause of edema., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects accuracy of patient records.
Mitigation Strategy
Ensure documentation specifies localized vs. generalized edema.
Impact
Inadequate documentation of whether edema is localized or generalized.
Mitigation Strategy
Use templates and checklists to ensure complete documentation.
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 Peripheral Edema, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Peripheral Edema
Use these documentation templates to ensure complete and accurate documentation for Peripheral Edema. These templates include all required elements for proper coding and billing.
Bilateral lower extremity edema
Specialty: CardiologyRequired Elements
- Location and extent of edema
- Pitting depth
- Associated symptoms
- Underlying cause
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Peripheral Edema? Ask your questions below.