Oncology & Hematology Coding Alert

Remember to distinguish localized vs generalized.

If you come across notes from your oncologist about “lymphadenopathy,” it means the patient has an abnormal enlargement of lymph nodes.

ICD-9-CM code: Diagnosis coding under ICD-9-CM points you to 785.6 (Enlargement of lymph nodes). The code also applies to the term “swollen glands.”

ICD-10-CM changes: When ICD-10-CM takes effect on Oct. 1, 2015, you will need to ascertain if your physician documented lymphadenopathy was localized to one particular region or generalized. Accordingly, you report codes R59.0 (Localized enlarged lymph nodes) and R59.1 (Generalized enlarged lymph nodes) for localized and generalized lymphadenopathy, respectively.

You’ll shift to code R59.9 (Enlarged lymph nodes, unspecified) when your physician does not document localized or generalized lymphadenopathy..

Do Not Confuse Lymphadenopathy with Lymphadenitis

The code 785.6 excludes lymphadenitis. For acute lymphadenitis, you report ICD-9-CM code 683 (Acute lymphadenitis). In ICD-10-CM, this code maps to following site-specific codes.

• L04.0, Acute lymphadenitis of face, head and neck
  
• L04.1, Acute lymphadenitis of trunk
  
• L04.2, Acute lymphadenitis of upper limb
  
• L04.3, Acute lymphadenitis of lower limb
  
• L04.8, Acute lymphadenitis of other sites
  

However, when your physician does not specify the site for lymphadenitis, you will submit ICD-10-CM code L04.9 (Acute lymphadenitis, unspecified).

For chronic lymphadenitis, you should submit ICD-9-CM code 289.1 (Chronic lymphadenitis) which maps to ICD-10-CM code I88.1 (Chronic lymphadenitis, except mesenteric).

When your physician does not specify the acute or chronic nature of lymphadenitis, you should submit ICD-9-CM code 289.3 (Lymphadenitis unspecified except mesenteric). This maps to two codes in ICD-10-CM: I88.9 (Nonspecific lymphadenitis, unspecified) and I88.8 (Other nonspecific lymphadenitis).

For nonspecific mesenteric lymphadenitis, you have ICD-9-CM code 289.2 (Nonspecific mesenteric lymphadenitis) and ICD-10-CM code I88.0 (Nonspecific mesenteric lymphadenitis).

Keep Complete Documentation

During the physical exam, your physician will evaluate and note the size, location, and character of lymphadenopathy as well as other physical findings that could suggest more serious lymphadenopathy (such as fever, anorexia, aches and pains, weight loss, and night sweats).

Some of the causes of lymphadenopathy are obvious, as with a patient who is diagnosed breast cancer presents with a non-tender enlargement of lymph nodes in the axilla. In other cases, it may not be clear.

Coding tip: The lymph nodes are found in the underarm, groin, neck, chest, and abdomen, and act as filters for the lymph fluid as it circulates through the body. Since lymphadenopathy is a sign of an underlying disease, make sure you use the patient’s history, symptoms, and physical examination to determine the source of infection, thus the appropriate diagnosis code.