Otolaryngology Coding Alert

The terms are not interchangeable.

If a patient sees your otolaryngologist because of enlarged lymph nodes in her neck, she might be diagnosed with lymphadenopathy or lymphadenitis. The two terms represent different conditions, however, so be sure to choose the correct diagnosis code based on your physician’s documentation.

ICD-9 choices: When you still coded by ICD-9, you reported 785.6 (Enlargement of lymph nodes) for lymphadenopathy, or swollen glands. For lymphadenitis, you submitted 289.1 (Chronic lymphadenitis) or 683 (Acute lymphadenitis).

Check Out Your ICD-10 Options

As with many other conditions, you have multiple code choices with ICD-10 that give more details about the patient’s condition.

Lymphadenopathy: Having more options means your physician needs to document whether the lymphadenopathy is localized to one particular region or generalized. Based on that information, the applicable codes are:

• R59.0 – Localized enlarged lymph nodes
• R59.1 – Generalized enlarged lymph nodes.

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

Lymphadenitis: ICD-10 has separate code families for chronic versus acute lymphadenitis. Diagnosis 683 for acute manifestations now maps to the 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.

For chronic lymphadenitis, report ICD-10 code I88.1 (Chronic lymphadenitis, except mesenteric).

Unspecified options: Once again, you have separate codes for when your physician does not specify the site for lymphadenitis, or whether the condition is acute or chronic. Those options include:

• L04.9 – Acute lymphadenitis, unspecified
• I88.8 – Other nonspecific lymphadenitis
• I88.9 – Nonspecific lymphadenitis, unspecified.

Documentation: Providers should base their diagnosis on evidence obtained from the physical exam, as well as from a biopsy and culture of the affected area. It may also reveal the cause of the inflammation. Your physician should point to a diagnosis of lymphadenitis or lymphadenopathy if the patient presents with palpable lymph nodes that may range in size from that of a small pea to that of a large marble. The swellings are often painful, and the skin above the area may be reddened and warm to the touch.