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ICD-10 Guide
ICD-10 CodesJ38.4

J38.4

Edema of larynx

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

Code Description

ICD-10 J38.4 is a billable code used to indicate a diagnosis of edema of larynx.

Key Diagnostic Point:

Edema of the larynx, classified under ICD-10 code J38.4, refers to the swelling of the laryngeal tissues, which can lead to significant respiratory distress. The larynx, located in the neck, plays a crucial role in breathing, phonation, and protecting the trachea against food aspiration. Edema may arise from various causes, including allergic reactions, infections (such as laryngitis), trauma, or irritants like smoke and chemicals. Clinically, patients may present with symptoms such as hoarseness, stridor, difficulty breathing, and a sensation of tightness in the throat. Disease progression can vary; acute edema may resolve quickly with appropriate treatment, while chronic conditions may require ongoing management. Diagnostic considerations include a thorough history and physical examination, laryngoscopy for direct visualization, and imaging studies if necessary. Timely diagnosis and intervention are critical to prevent airway obstruction and ensure patient safety.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of symptoms and potential underlying causes.
  • Treatment complexity: Management may involve medications, airway interventions, or surgical options depending on severity.
  • Documentation requirements: Detailed clinical notes are essential to justify the diagnosis and treatment plan.
  • Coding specificity: Accurate coding requires understanding of the specific nature and cause of the edema.

Audit Risk Factors

  • Common coding errors: Misclassification of edema as obstruction or other laryngeal conditions.
  • Documentation gaps: Insufficient detail regarding the cause and severity of edema.
  • Billing challenges: Potential denials due to lack of clear clinical justification for the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: Otolaryngology

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: Pulmonology

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Edema of the larynx can significantly impact patient health, leading to acute respiratory distress and potential hospitalization. Understanding the epidemiology of this condition is crucial, as it can arise from various sources, including environmental allergens and infectious agents. Effective management of laryngeal edema is essential for improving patient outcomes, reducing healthcare utilization, and enhancing quality measures related to respiratory health.

ICD-9 vs ICD-10

Edema of the larynx can significantly impact patient health, leading to acute respiratory distress and potential hospitalization. Understanding the epidemiology of this condition is crucial, as it can arise from various sources, including environmental allergens and infectious agents. Effective management of laryngeal edema is essential for improving patient outcomes, reducing healthcare utilization, and enhancing quality measures related to respiratory health.

Reimbursement & Billing Impact

Reimbursement may be affected by the specificity of the diagnosis and the completeness of the documentation. Common denials may arise from insufficient justification for the medical necessity of procedures performed. Best practices include thorough documentation of the clinical encounter and ensuring that all relevant codes are accurately reported.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J38.4?

J38.4 covers conditions leading to laryngeal edema, including allergic reactions, infections, and trauma. It is essential to differentiate it from other laryngeal disorders such as laryngeal neoplasms or chronic laryngitis.

When should J38.4 be used instead of related codes?

J38.4 should be used when the primary issue is edema of the larynx, particularly when it is causing respiratory symptoms. If the edema is secondary to another condition, the underlying cause should be coded instead.

What documentation supports J38.4?

Documentation should include a detailed clinical assessment, including symptoms, duration, and any precipitating factors. Laryngoscopy findings and treatment plans should also be clearly documented.