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ICD-10 Guide
ICD-10 CodesL04.9

L04.9

Billable

Acute lymphadenitis, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 L04.9 is a billable code used to indicate a diagnosis of acute lymphadenitis, unspecified.

Key Diagnostic Point:

Acute lymphadenitis, unspecified, is characterized by the inflammation of lymph nodes, which can occur due to various infectious agents, including bacteria, viruses, or fungi. Clinically, patients may present with swollen, tender lymph nodes, often accompanied by systemic symptoms such as fever, malaise, and localized pain. The lymphatic system, comprising lymph nodes and vessels, plays a crucial role in immune response and fluid balance. Acute lymphadenitis can progress rapidly, leading to complications such as abscess formation if not treated promptly. Diagnostic considerations include a thorough clinical history, physical examination, and, when necessary, imaging studies or laboratory tests to identify the underlying cause. Differential diagnoses may include other forms of lymphadenopathy, such as reactive hyperplasia or malignancy, necessitating careful evaluation to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other lymphadenopathy causes.
  • Treatment complexity: May involve antibiotics or surgical intervention for abscess.
  • Documentation requirements: Detailed clinical notes needed to justify diagnosis.
  • Coding specificity: Limited specificity as it is unspecified lymphadenitis.

Audit Risk Factors

  • Common coding errors: Misclassification with chronic lymphadenitis codes.
  • Documentation gaps: Insufficient detail on the cause or location of lymphadenitis.
  • Billing challenges: Potential denials if documentation does not support acute diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: Infectious Disease

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Secondary specialty: Dermatology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute lymphadenitis can significantly impact patient health, leading to complications if untreated. It is essential for healthcare providers to recognize and manage this condition promptly to prevent further morbidity. Understanding the epidemiology of lymphadenitis, including its prevalence in certain populations, can guide public health initiatives and improve healthcare delivery. Quality measures may include timely diagnosis and treatment, which are critical for reducing healthcare utilization and improving patient outcomes.

ICD-9 vs ICD-10

Acute lymphadenitis can significantly impact patient health, leading to complications if untreated. It is essential for healthcare providers to recognize and manage this condition promptly to prevent further morbidity. Understanding the epidemiology of lymphadenitis, including its prevalence in certain populations, can guide public health initiatives and improve healthcare delivery. Quality measures may include timely diagnosis and treatment, which are critical for reducing healthcare utilization and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the documentation supports the acute nature of the condition. Common denials may arise from insufficient detail in the medical record or failure to demonstrate medical necessity for diagnostic tests or treatments. Best practices include using specific codes when possible and ensuring that all documentation aligns with the services billed.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by L04.9?

L04.9 covers acute lymphadenitis without specifying the cause or location. It may include infections from common pathogens like Staphylococcus aureus or Streptococcus species, but does not detail specific infectious agents.

When should L04.9 be used instead of related codes?

L04.9 should be used when acute lymphadenitis is diagnosed but the specific site or cause is not identified. If the lymphadenitis is localized or due to a specific infection, more specific codes should be utilized.

What documentation supports L04.9?

Documentation should include clinical findings such as the location of lymphadenopathy, associated symptoms, and any diagnostic tests performed. A clear rationale for the acute diagnosis is essential.