“Edema, bilateral lower extremities”

[tetrok]

Having a disagreement with billing the symptom of “edema, bilateral lower extremities”

Colleague insists R60.0 Localized Edema

I had been trained most specific code for this is R22.43 Localized swelling, mass and lump, lower limb, bilateral

Tried explaining the medical definition of edema IS SWELLING and R22.43 is the most specific dx code.
Colleague justifies since the 3m encoder doesn’t correlate edema to swelling, that edema is a completely separate symptom of swelling, essentially stating it’s a non relatable to code R22.43

How is everyone else coding this symptom when the swelling/edema/fluid retention is specific to the body area?

Silly debate, yes…but is driving me nuts and affecting my audit score

 

[thomas7331]

Your colleague is correct - edema of the lower extremities not further specified is coded as R60.0, per ICD-10 guidelines.

I can't speak to how your training might have directed you, but when selecting ICD-10 codes, you shouldn't be trying to find the best match for a medical definition of a term - that can often take you to an incorrect code. Per the guidelines, section I.B.1: "To select a code in the classification that corresponds to a diagnosis or reason for visit documented in a medical record, first locate the term in the Alphabetic Index, and then verify the code in the Tabular List. So under the term 'edema' in the alphabetic index, you'll find a sub-term 'legs' which directs you to R60.0. Looking then in the Tabular List, you can review the Excludes1 notes to verify that none of the codes listed there apply. There is no term under 'edema' in the Alphabetic Index or under R60.0 in the Tabular List to direct you to R22.43, so there's no way to arrive at that code from this diagnosis.

Codes are classifications of conditions, not definitions, so you have to stick to this process to arrive at the correct code for any particular term in the provider's documentation. If you're selecting a code based on your assessment of how closely the language of the code descriptor matches the term rather than following the process of starting with the alphabetic index, this will result in incorrect coding.