ICD-10 Coding for Swollen Glands(R59.0, R59.1, R59.9, L04.9)
Complete ICD-10-CM coding and documentation guide for Swollen Glands. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Swollen Glands
R59Primary Range
Enlarged lymph nodes
This range covers the primary codes for lymphadenopathy, distinguishing between localized, generalized, and unspecified lymph node enlargement.
Acute lymphadenitis
This range is used for coding acute lymphadenitis, which is an infection of the lymph nodes.
Nonspecific lymphadenitis
This range is used for chronic or nonspecific lymphadenitis, where the infection or inflammation is not acute.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R59.0 | Localized enlarged lymph nodes | Use when lymphadenopathy is confined to a single region, such as cervical or axillary. |
|
| R59.1 | Generalized enlarged lymph nodes | Use when lymphadenopathy is present in two or more regions. |
|
| R59.9 | Enlarged lymph nodes, unspecified | Use when documentation does not specify whether lymphadenopathy is localized or generalized. |
|
| L04.9 | Acute lymphadenitis, unspecified | Use when acute lymphadenitis is present but the site is unspecified. |
|
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 swollen glands
Essential facts and insights about Swollen Glands
Primary ICD-10-CM Codes for swollen glands
Decision Criteria
clinical Criteria
- Lymph node enlargement in a single region
Applicable To
- Localized lymphadenopathy
Clinical Validation Requirements
- Documentation of lymph node enlargement in one region
- Physical exam findings such as size and tenderness
Code-Specific Risks
- Misclassification if generalized lymphadenopathy is present
Coding Notes
- Ensure documentation specifies the region of lymphadenopathy to use this code.
R59.1 - Generalized enlarged lymph nodes
Use when lymphadenopathy is present in two or more regions.
Applicable To
- Generalized lymphadenopathy
Excludes
- Localized lymphadenopathy (R59.0)
- Lymphadenitis (L04.-)
Clinical Validation Requirements
- Documentation of lymph node enlargement in multiple regions
- Associated systemic symptoms like fever or weight loss
Coding Notes
Ensure documentation specifies multiple regions of lymphadenopathy.
R59.9 - Enlarged lymph nodes, unspecified
Use when documentation does not specify whether lymphadenopathy is localized or generalized.
Applicable To
- Lymphadenopathy NOS
Excludes
- Localized lymphadenopathy (R59.0)
- Generalized lymphadenopathy (R59.1)
Clinical Validation Requirements
- Lack of specification on the distribution of lymphadenopathy
Coding Notes
Query for more specific information if possible.
L04.9 - Acute lymphadenitis, unspecified
Use when acute lymphadenitis is present but the site is unspecified.
Applicable To
- Acute lymphadenitis NOS
Excludes
- Chronic lymphadenitis (I88.-)
Clinical Validation Requirements
- Documentation of acute infection of lymph nodes
- Presence of symptoms like redness, warmth, and tenderness
Coding Notes
Ensure documentation specifies acute nature and symptoms.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Swollen Glands to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R59.0.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Increases risk of audit and non-compliance., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Train staff on the importance of detailed documentation, Use templates to guide thorough documentation
Impact
Reimbursement: May lead to lower reimbursement due to lack of specificity., Compliance: Increases risk of audit for unspecified coding., Data Quality: Reduces data accuracy for clinical research and reporting.
Mitigation Strategy
Query for clarification on whether lymphadenopathy is localized or generalized.
Impact
Reimbursement: Incorrect coding can affect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts clinical data integrity.
Mitigation Strategy
Ensure documentation specifies whether infection is present to use L04 codes.
Impact
Increased scrutiny on the use of R59.9 for unspecified lymphadenopathy.
Mitigation Strategy
Encourage detailed documentation and use of specific codes.
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 Swollen Glands, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Swollen Glands
Use these documentation templates to ensure complete and accurate documentation for Swollen Glands. These templates include all required elements for proper coding and billing.
Acute lymphadenitis in primary care
Specialty: Primary CareRequired Elements
- Location and size of lymph nodes
- Presence of tenderness and warmth
- Associated symptoms like fever
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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