Cardiology Coding Alert

Check the index to keep fluid retention coding on track.

The next time you code edema, check to see if the documentation clarifies whether it is localized or generalized. If not, it’s time for a documentation tune-up so you’re ready for ICD-10. 

ICD-9-CM Code

• 782.3, Edema

ICD-10-CM Codes

• R60.0, Localized edema

• R60.1, Generalized edema

• R60.9, Edema unspecified

Edema is swelling due to fluid trapped in body tissues. Generalized edema refers to swelling that involves the entire body. Localized edema occurs in a defined area, typically the legs. Diseases such as congestive heart failure and drugs such as certain blood pressure medications may cause edema or make it worse.

ICD-9 coding rules: Notes with 782.3 tell you the code applies to documentation of anasarca, which is extreme edema involving the entire body. The code also applies to dropsy, according to the note, although this is an older term. Localized edema NOS (not otherwise specified) also falls under 782.3.

ICD-10 changes: When reporting edema under ICD-10, you’ll choose from codes for localized (R60.0), generalized (R60.1), and unspecified (R60.9). 

Note that ICD-10 includes fluid retention NOS under unspecified edema code R60.9. This differs from ICD-9, which puts fluid retention under 276.69 (Other fluid overload). This diagnosis is a good example of why you need to use the index rather than simply crossing your old ICD-9 codes to ICD-10. ICD-10 has distinct fluid overload codes, such as E87.79 (Other fluid overload), but they would not be correct for fluid retention, according to the index.

Documentation: To choose the most specific ICD-10 code, the provider will need to document whether the edema is localized or generalized. Without that information, you will have to choose the unspecified code R60.9.

Coder tips: The edema codes are in Chapter 18, which includes signs and symptoms. The ICD-10 Official Guidelines, Section I.B.4, state that you may use signs and symptoms codes when the provider has not established or confirmed a related definitive diagnosis.

Remember: CMS has announced Oct. 1, 2015, as the compliance date for ICD-10. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.