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v1.0.0
ICD-10 Guide
ICD-10 CodesR22.40

R22.40

Localized swelling, mass and lump, unspecified lower limb

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

Code Description

ICD-10 R22.40 is a billable code used to indicate a diagnosis of localized swelling, mass and lump, unspecified lower limb.

Key Diagnostic Point:

R22.40 refers to localized swelling, mass, or lump in the unspecified lower limb. This code is used when a patient presents with a palpable mass or swelling in the lower extremities that cannot be specifically classified under other diagnoses. The swelling may be due to various underlying conditions, including infections, tumors, hematomas, or inflammatory processes. Clinical evaluation typically involves a thorough history and physical examination, focusing on the characteristics of the mass (size, tenderness, mobility) and associated symptoms such as pain, redness, or warmth. Diagnostic imaging (e.g., ultrasound, MRI) may be warranted to assess the mass's nature and guide further management. Laboratory tests may also be performed to rule out infectious or inflammatory causes. Accurate coding requires careful documentation of the clinical findings and any diagnostic tests performed to support the diagnosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and underlying causes
  • Need for thorough documentation to support the diagnosis
  • Potential overlap with other codes for similar symptoms
  • Requirement for additional diagnostic tests to clarify the condition

Audit Risk Factors

  • Inadequate documentation of the mass characteristics
  • Failure to specify the location of the swelling
  • Lack of supporting diagnostic tests in the medical record
  • Misuse of the code when a more specific diagnosis is available

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of the mass, including onset, duration, and associated symptoms; physical examination findings; and any diagnostic imaging results.

Common Clinical Scenarios

Patients presenting with unexplained swelling in the lower limb, often requiring further evaluation to rule out serious conditions.

Billing Considerations

Ensure that the documentation clearly states the reason for using R22.40 and that no other specific diagnosis applies.

Emergency Medicine

Documentation Requirements

Acute assessment of the mass, including vital signs, pain assessment, and immediate imaging or lab results if applicable.

Common Clinical Scenarios

Patients with acute swelling due to trauma, infection, or allergic reactions requiring rapid diagnosis and treatment.

Billing Considerations

Document the acute nature of the presentation and any interventions performed to support the use of R22.40.

Coding Guidelines

Inclusion Criteria

Use R22.40 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the swelling is not classified elsewhere and that all documentation supports the diagnosis

Exclusion Criteria

Do NOT use R22.40 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when evaluating a patient with localized swelling in the lower limb.

Documentation Requirements

Document the history, examination findings, and any treatment plans.

Specialty Considerations

Ensure that the visit level reflects the complexity of the evaluation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding, but R22.40 remains a catch-all for unspecified cases, which can lead to increased scrutiny during audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding, but R22.40 remains a catch-all for unspecified cases, which can lead to increased scrutiny during audits.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding, but R22.40 remains a catch-all for unspecified cases, which can lead to increased scrutiny during audits.

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

When should I use R22.40?

Use R22.40 when a patient presents with localized swelling, mass, or lump in the lower limb that cannot be classified under a more specific diagnosis.