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ICD-10 Guide
ICD-10 CodesChapter 12: Diseases of the skin and subcutaneous tissueL04

L04

Non-billable

Acute lymphadenitis

Chapter 12:Diseases of the skin and subcutaneous tissue

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

Code Description

ICD-10 L04 is a used to indicate a diagnosis of acute lymphadenitis.

Key Diagnostic Point:

Acute lymphadenitis is an inflammatory condition characterized by the swelling and tenderness of lymph nodes, often due to infection. Clinically, patients may present with localized pain, fever, and systemic symptoms such as malaise. The condition typically involves lymph nodes in the neck, axilla, or groin, depending on the site of infection. The underlying anatomy includes lymphatic vessels and nodes, which play a crucial role in the immune response. Disease progression can vary; if untreated, acute lymphadenitis may lead to abscess formation or systemic infection. Diagnostic considerations include a thorough clinical examination, patient history, and imaging studies such as ultrasound or CT scans to assess lymph node involvement. Laboratory tests may also be performed to identify the causative organism, which is often bacterial, such as Staphylococcus aureus or Streptococcus species. Early diagnosis and treatment are essential to prevent complications and ensure effective management of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of lymphadenopathy as lymphadenitis.
  • Documentation gaps may arise from insufficient detail on the site and cause of lymphadenitis.
  • Billing challenges often stem from the need for comprehensive documentation to support the diagnosis.

Specialty Focus

Medical Specialties

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

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 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 not treated promptly. It is essential for population health as it can indicate underlying infections that may affect broader community health. Quality measures may include timely diagnosis and treatment, which can improve healthcare utilization patterns. Epidemiologically, the condition is more prevalent in certain populations, such as children and immunocompromised individuals, highlighting the need for targeted healthcare strategies.

ICD-9 vs ICD-10

Acute lymphadenitis can significantly impact patient health, leading to complications if not treated promptly. It is essential for population health as it can indicate underlying infections that may affect broader community health. Quality measures may include timely diagnosis and treatment, which can improve healthcare utilization patterns. Epidemiologically, the condition is more prevalent in certain populations, such as children and immunocompromised individuals, highlighting the need for targeted healthcare strategies.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may occur if documentation does not clearly establish the diagnosis or if the treatment provided is not adequately justified. Best practices include ensuring that all clinical findings, laboratory results, and imaging studies are documented and linked to the diagnosis to support claims.

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?

L04 covers acute lymphadenitis, which can be caused by bacterial, viral, or fungal infections. Specific conditions include suppurative lymphadenitis, non-suppurative lymphadenitis, and lymphadenitis due to specific pathogens.

When should L04 be used instead of related codes?

L04 should be used when there is a clear diagnosis of acute lymphadenitis, particularly when there is evidence of inflammation and infection in the lymph nodes. It should not be used for chronic lymphadenopathy or other non-infectious causes.

What documentation supports L04?

Documentation should include clinical findings such as lymph node size, tenderness, and systemic symptoms. Laboratory results indicating infection and imaging studies confirming lymph node involvement are also critical.