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ICD-10 Guide
ICD-10 CodesR22.43

R22.43

Localized swelling, mass and lump, lower limb, bilateral

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

Code Description

ICD-10 R22.43 is a billable code used to indicate a diagnosis of localized swelling, mass and lump, lower limb, bilateral.

Key Diagnostic Point:

Localized swelling, mass, and lump in the lower limb, bilateral, refers to the presence of abnormal tissue growth or fluid accumulation in both lower limbs. This condition can manifest as visible swelling, palpable masses, or lumps that may vary in size and consistency. The swelling can be due to various underlying causes, including inflammatory processes, infections, tumors, or vascular issues. Patients may present with associated symptoms such as pain, tenderness, or changes in skin color. Clinical evaluation often includes a thorough history and physical examination, imaging studies, and possibly laboratory tests to determine the underlying etiology. Accurate diagnosis is crucial as it guides treatment decisions and helps in identifying any serious underlying conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (e.g., infections, tumors, vascular issues)
  • Need for comprehensive clinical evaluation and differential diagnosis
  • Variability in presentation and associated symptoms
  • Potential for overlapping symptoms with other conditions

Audit Risk Factors

  • Inadequate documentation of bilateral involvement
  • Failure to specify the underlying cause of swelling
  • Misclassification of the condition as unilateral
  • Lack of supporting clinical findings in the medical record

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of present illness, physical examination findings, and any diagnostic imaging results.

Common Clinical Scenarios

Patients presenting with bilateral leg swelling due to heart failure, renal issues, or venous insufficiency.

Billing Considerations

Ensure to document any chronic conditions that may contribute to the swelling.

Emergency Medicine

Documentation Requirements

Acute assessment findings, including vital signs, and any immediate interventions performed.

Common Clinical Scenarios

Acute presentations of bilateral swelling due to trauma, allergic reactions, or infections.

Billing Considerations

Rapid assessment and documentation of potential life-threatening causes are critical.

Coding Guidelines

Inclusion Criteria

Use R22.43 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the bilateral nature of the condition is clearly documented
  • Use additional codes to specify underlying conditions when applicable

Exclusion Criteria

Do NOT use R22.43 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for patients with bilateral swelling.

Documentation Requirements

Document the history, examination, and any changes in treatment.

Specialty Considerations

Ensure to note any chronic conditions affecting the patient's status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like bilateral localized swelling, improving the granularity of data for clinical and billing purposes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like bilateral localized swelling, improving the granularity of data for clinical and billing purposes.

Reimbursement & Billing Impact

billing purposes.

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 be documented to support the use of R22.43?

Documentation should include a detailed history of the swelling, physical examination findings, any imaging or lab results, and a clear statement of the bilateral nature of the condition.