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ICD-10 Guide
ICD-10 CodesJ84.81

J84.81

Lymphangioleiomyomatosis

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

Code Description

ICD-10 J84.81 is a billable code used to indicate a diagnosis of lymphangioleiomyomatosis.

Key Diagnostic Point:

Lymphangioleiomyomatosis (LAM) is a rare lung disease characterized by the abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs, leading to the obstruction of lymphatic vessels and the formation of cystic lung lesions. Clinically, patients often present with progressive dyspnea, cough, and recurrent pneumothorax. The disease primarily affects women of childbearing age, and its etiology is linked to mutations in the TSC2 gene, which is associated with tuberous sclerosis complex. As LAM progresses, it can lead to significant respiratory impairment and reduced quality of life. Diagnostic considerations include high-resolution computed tomography (HRCT) scans, which reveal characteristic cystic changes in the lungs, and lung function tests to assess the degree of airflow obstruction. A multidisciplinary approach is often required for management, including pulmonology, genetics, and sometimes oncology, due to the potential for associated renal tumors. Early diagnosis and intervention are crucial to managing symptoms and improving patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and genetic testing for confirmation.
  • Treatment complexity: Management may involve multiple specialties and therapies.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Accurate coding requires understanding of the disease's nuances.

Audit Risk Factors

  • Common coding errors: Misclassification with other lung diseases.
  • Documentation gaps: Incomplete clinical history or imaging reports.
  • Billing challenges: Potential denials due to lack of clear diagnostic evidence.

Specialty Focus

Medical Specialties

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

Genetics

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

Lymphangioleiomyomatosis significantly impacts affected individuals, leading to progressive respiratory failure and decreased quality of life. Its rarity poses challenges in population health monitoring and resource allocation. Understanding LAM's epidemiology is crucial for developing targeted interventions and improving healthcare utilization patterns, particularly in women of childbearing age who are most affected by this condition.

ICD-9 vs ICD-10

Lymphangioleiomyomatosis significantly impacts affected individuals, leading to progressive respiratory failure and decreased quality of life. Its rarity poses challenges in population health monitoring and resource allocation. Understanding LAM's epidemiology is crucial for developing targeted interventions and improving healthcare utilization patterns, particularly in women of childbearing age who are most affected by this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough clinical documentation to support the diagnosis, as well as potential prior authorization for specialized imaging and treatments. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include maintaining clear and detailed notes on patient history, symptoms, and diagnostic tests to ensure compliance and reduce audit risks.

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 J84.81?

J84.81 specifically covers lymphangioleiomyomatosis, a rare lung disease characterized by cystic lung lesions and lymphatic obstruction due to the proliferation of LAM cells. It is primarily associated with women and can be linked to tuberous sclerosis.

When should J84.81 be used instead of related codes?

J84.81 should be used when a patient is diagnosed with lymphangioleiomyomatosis, particularly when imaging studies show characteristic cystic changes and when other lung diseases have been ruled out.

What documentation supports J84.81?

Documentation for J84.81 should include clinical notes detailing symptoms, imaging results showing cystic lung changes, and any genetic testing results confirming TSC2 mutations.