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ICD-10 Guide
ICD-10 CodesR22.31

R22.31

Localized swelling, mass and lump, right upper limb

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R22.31 is a billable code used to indicate a diagnosis of localized swelling, mass and lump, right upper limb.

Key Diagnostic Point:

R22.31 refers to localized swelling, mass, or lump specifically in the right upper limb. This condition can manifest as a palpable mass or swelling that may be associated with various underlying causes, including infections, tumors, hematomas, or inflammatory processes. The right upper limb encompasses the shoulder, arm, forearm, wrist, and hand, and swelling in this area can result from trauma, overuse, or systemic conditions such as arthritis. Clinical evaluation typically involves a thorough history and physical examination, focusing on the characteristics of the mass (size, tenderness, mobility), associated symptoms (pain, redness, warmth), and any recent injuries or infections. Imaging studies such as ultrasound or MRI may be warranted to assess the nature of the mass, while laboratory tests can help identify underlying infections or inflammatory markers. Accurate coding requires careful documentation of the clinical findings and any relevant diagnostic tests performed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes
  • Need for detailed clinical documentation
  • Differentiation from similar codes
  • Potential for overlapping symptoms with other conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the location of the mass
  • Misclassification of the mass as benign or malignant without proper evaluation
  • Lack of follow-up documentation for ongoing conditions

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of present illness, physical examination findings, and any relevant lab results.

Common Clinical Scenarios

Patients presenting with unexplained swelling in the right arm, possibly due to systemic conditions like rheumatoid arthritis or localized infections.

Billing Considerations

Consideration of comorbidities that may affect swelling, such as heart failure or renal disease.

Emergency Medicine

Documentation Requirements

Acute care documentation including mechanism of injury, vital signs, and immediate treatment provided.

Common Clinical Scenarios

Acute trauma leading to swelling or hematoma formation in the right upper limb.

Billing Considerations

Rapid assessment and documentation of any life-threatening conditions that may present with similar symptoms.

Coding Guidelines

Inclusion Criteria

Use R22.31 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the swelling, mass, or lump is localized to the right upper limb and not due to systemic conditions

Exclusion Criteria

Do NOT use R22.31 When
No specific exclusions found.

Related CPT Codes

73030CPT Code

Radiologic examination, shoulder

Clinical Scenario

When imaging is performed to evaluate the cause of swelling.

Documentation Requirements

Document the reason for imaging and findings.

Specialty Considerations

Ensure that the imaging is relevant to the clinical presentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of localized conditions, improving the granularity of data for clinical analysis and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of localized conditions, improving the granularity of data for clinical analysis and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should I document to support the use of R22.31?

Document the location, size, characteristics of the swelling or mass, any associated symptoms, and results of diagnostic tests.