Edema ICD 10 coding is made easier with our billing guidelines. This article includes all medical codes you will need to report edema and related specific codes, such as pulmonary and periorbital edema.
Read on for a summary of the necessary codes followed by a further description.
What Is Edema?
Edema (or Oedema) is the abnormal accumulation of fluid in certain tissues within the body.
The definition of edema is observable swelling from fluid accumulation in body tissues. When parts of the body are affected with edema, they are considered edematous.
The fluid accumulation may be under the skin – usually in dependent areas such as the legs (peripheral edema or ankle edema), or it may accumulate in the lungs (pulmonary edema).
Symptoms will depend on the cause of the edema.
Symptoms of peripheral edema include swelling of the affected area(s), which causes the surrounding skin to “tighten.”
The swelling from peripheral edema is gravity-dependent (it will increase or decrease with changes in body position).
For example, if a person is lying on their back (supine), swelling will not appear in the legs but in the area around the sacrum.
The skin over the swollen area appears tight and shiny, and often when pressure is applied to the area with a finger, an indentation appears. This is called pitting edema.
What Is Pulmonary Edema?
In the case of pulmonary edema, there is often no evidence of fluid retention or noticeable swelling on examination of the patient’s extremities.
This is because the fluid is backing up into the lungs. Signs and symptoms of pulmonary edema include:
- Shortness of breath,
- Difficulty breathing when lying flat,
- Waking up breathless,
- Requiring multiple pillows to raise the head at night for a comfortable sleep.
Causes of edema include:
- Eating too much salt
- Heart failure
- Kidney disease
- Liver problems from cirrhosis
- Problems with lymph nodes, especially after mastectomy
- Some medicines
- Standing or walking a lot when the weather is warm.
Treatment depends on the condition that causes edema. Generally, the goal of treatment is to reverse the fluid accumulation causing forces;
- Increase the forces that keep fluid inside the blood vessels.
- Reduce the forces that cause fluid to leak out of the blood vessels.
- Identify the cause of the leaking blood vessel walls.
For example, increasing blood protein (albumin) in a malnourished patient can help keep fluids in the bloodstream.
In addition, healing tissues exposed to trauma (for example, inflammation from a bent ankle) helps prevent fluid leakage into blood vessels.
The main goal in the treatment of edema is to remove excess fluid accumulated in the surrounding tissues.
The most common treatment is diuretic. Diuretics make the kidneys excrete excess fluid, which reduces the amount of normal fluid in the body.
However, diuretics should be used caution as dehydration can have serious side effects. In addition, many different diuretics have different mechanisms of action and different strengths.
Edema ICD 10
Edema ICD 10 is coded as R60.
It can be found in chapter XVII of the ICD 10 book, which codes for Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), under the block R50-R69, which codes for General symptoms and signs, it is found as a broad category R60 which codes for edema not elsewhere classified.
The subcategories include:
R60.0 – Localized edema
R60.1 – Generalized edema
R60.9 – Edema unspecified
Pulmonary Edema ICD 10
Pulmonary edema is not classified together with another unclassified edema in chapter Xviii.
Still, it is classified in chapter X J00-J99 Diseases of the respiratory system under the block J80-J84 Other respiratory diseases principally affect the interstitium and the category J81 Pulmonary edema.
J81.0 is a billable/specific ICD 10 CM code that can be used to indicate a diagnosis for reimbursement purposes.
The 2022 edition of ICD 10 CM J81.0 became effective on October 1, 2021.
The sub-codes include:
J81.0 – Acute pulmonary edema
J81.1 – Chronic pulmonary edema
Lower Extremity Edema ICD 10
The ICD 10 code for Localized swelling, mass, and a lump in the lower limb is R22.4.
The sub-codes are:
R22.4 – Localized swelling, mass, and lump, lower limb.
R22.40 – Localized swelling, mass, and lump, unspecified lower limb.
R22.41 – Localized swelling, mass, and lump, right lower limb.
R22.42 – Localized swelling, mass, and lump, left lower limb.
R22.43 – Localized swelling, mass, and lump, lower limb, bilateral.
Upper limb localized swelling will be coded as:
R22.3 – Localized swelling, mass, and lump, upper limb.
R22.30 – Localized swelling, mass, and lump, unspecified upper limb.
R22.31 – Localized swelling, mass, and lump, right upper limb.
R22.32 – Localized swelling, mass, and lump, left upper limb.
R22.33 – Localized swelling, mass, and lump, upper limb, bilateral.
However, edematous swelling of the lower limb due to fluid accumulation will be coded as R60.0.
Peripheral Edema ICD 10
Localized swelling of the limbs will be coded as above.
While edematous swelling of the limb will be coded as R60.0.
Bilateral Lower Extremity Edema ICD 10
The ICD 10 code for Localized swelling, mass, lump, lower limb, bilateral is R22.43.
Macular Edema ICD 10
The ICD 10 code for macular edema/retina edema is H35.81.
It can be found in Chapter Vii – Diseases of the eye and adnexa (H00-H59) under the block Disorders of choroid and retina (H30-H36), and the category Other specified retinal disorders (H35.8).
The sub-codes under this include:
H35.81 – Retinal edema
H35.82 – Retinal ischemia
H35.89 – Other specified retinal disorders
Cerebral Edema ICD 10
Cerebral edema ICD 10 is coded as G93.6.
This can be found in Chapter 6 – Diseases of the nervous system (G00-G99) under the block Other disorders of the nervous system (G89-G99) and the category Other disorders of the brain (G93).
The sub-codes under this category include:
G93.0 – Cerebral cysts
G93.1 – Anoxic brain damage, not elsewhere classified
G93.2 – Benign intracranial hypertension
G93.3 – Postviral fatigue syndrome
G93.4 – Other and unspecified encephalopathy
G93.5 – Compression of the brain
G93.6 – Cerebral edema
G93.7 – Reye’s syndrome
G93.8 – Other specified disorders of the brain
G93.9 – Disorder of brain, unspecified
Vasogenic Edema ICD 10
Vasogenic edema occurs due to alterations in the blood-brain barrier (BBB) with a breakdown in the tight endothelial junctions, resulting in a plasma-derived protein-rich exudate.
Thus it is coded the same way as cerebral edema G93.6.
Scrotal Edema ICD 10
The code for scrotal edema is N50.8.
N50.8 should not be used for reimbursement purposes as multiple codes below it contains a greater level of detail.
The 2022 edition of ICD 10 CM N50.8 became effective on October 1, 2021.
It can be selected in chapter XIV N00-N99 Diseases of the genitourinary system, under the block N40-N53 Diseases of male genital organs and the category N50 Other and unspecified disorders of male genital organs.
Dependent Edema ICD 10
Dependent edema will also be coded under R60.
Periorbital Edema ICD 10
Periorbital edema ICD 10 is coded as H05.22.
It can be found in chapter VIII H00-H59 Diseases of the eye and adnexa, under the block H00-H05 Disorders of eyelid, lacrimal system, and orbit and the category H05- Disorders of orbit.
Corneal edema ICD 10 is coded as H18.2.
It can be found in Chapter 7 Diseases of the eye and adnexa (H00-H59), under the block Disorders of sclera, cornea, iris, and ciliary body (H15-H22), and under the category Other and unspecified corneal edema (H18.2).
The sub-codes under this category:
H18.20 – Unspecified corneal edema
H18.21 – Corneal edema secondary to contact lens
H18.22 – Idiopathic corneal edema
H18.23 – Secondary corneal edema
Interstitial Edema ICD 10
Pulmonary interstitial edema represents a form of pulmonary edema resulting from pathological fluid buildup in the interstitial spaces due to increased hydrostatic driving pressure.
And it will be coded the same way as pulmonary edema J81.0.
Facial edema ICD 10 is coded as Localized swelling, mass, and lump in the head, R22.0. At the same time, localized edematous swelling will be R60.0.
Eyelid edema ICD 10 is coded as H02.84.
H02.84 should not be used for reimbursement purposes as multiple codes below it contains a greater level of detail.
The 2022 edition of ICD 10 CM H02.84 became effective on October 1, 2021.
Edema ICD 11
The ICD 11 code for edema generally can be found in chapter 26, which codes for Supplementary Chapter Traditional Medicine Conditions – Module I Traditional medicine disorders (TM1) and is coded as (SA00-SE5Z).
It is found under the block Organ system disorders (TM1) (SA00-SB2Z) under the category Kidney system disorders (TM1) (SA90-SB0Z) with the sub-code SB06 coding for Edema disorders (TM1).
Sections/codes in SB06 include:
Kidney edema disorder (TM1) (SB06.0).
Wind edema disorder (TM1) (SB06.1).
Other specified edema disorders (TM1) (SB06.Y).
Edema disorders (TM1), unspecified (SB06.Z).