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v1.0.0
ICD-10 Guide
ICD-10 CodesR23.1

R23.1

Pallor

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

Code Description

ICD-10 R23.1 is a billable code used to indicate a diagnosis of pallor.

Key Diagnostic Point:

Pallor is a clinical sign characterized by an abnormal paleness of the skin or mucous membranes, which can indicate a variety of underlying health issues. It is often assessed visually and can be quantified through laboratory tests measuring hemoglobin levels or other indicators of blood volume and circulation. Pallor may result from decreased blood flow, anemia, or other systemic conditions affecting blood oxygenation. Common causes include iron deficiency anemia, chronic diseases, acute blood loss, and shock. In clinical practice, pallor is frequently evaluated alongside other symptoms such as fatigue, weakness, or shortness of breath to determine the underlying etiology. It is essential for healthcare providers to conduct a thorough history and physical examination, as well as appropriate laboratory tests, to ascertain the cause of pallor and guide treatment. The presence of pallor can be a critical sign in emergency settings, indicating potential life-threatening conditions that require immediate intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes that can lead to pallor
  • Need for comprehensive patient history and physical examination
  • Potential overlap with other ICD-10 codes for anemia and shock
  • Variability in clinical presentation among different patient populations

Audit Risk Factors

  • Inadequate documentation of the underlying cause of pallor
  • Failure to link pallor to a specific diagnosis
  • Misuse of R23.1 when a more specific code is available
  • Lack of supporting lab results or clinical findings

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, physical examination findings, and lab results supporting the diagnosis of pallor.

Common Clinical Scenarios

Patients presenting with fatigue and pallor due to anemia or chronic illness.

Billing Considerations

Consideration of comorbidities that may contribute to pallor, such as renal failure or malignancies.

Emergency Medicine

Documentation Requirements

Acute assessment of pallor, vital signs, and immediate lab results to rule out shock or severe anemia.

Common Clinical Scenarios

Patients presenting with acute pallor due to trauma, hemorrhage, or sepsis.

Billing Considerations

Rapid assessment and documentation are crucial for timely intervention.

Coding Guidelines

Inclusion Criteria

Use R23.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that R23
  • 1 is used only when pallor is not classified elsewhere
  • Document the clinical context and any relevant lab findings

Exclusion Criteria

Do NOT use R23.1 When
No specific exclusions found.

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with automated differential

Clinical Scenario

Used to evaluate the cause of pallor in patients presenting with anemia.

Documentation Requirements

Document the indication for the CBC and any relevant findings.

Specialty Considerations

Internal medicine may focus on chronic conditions, while emergency medicine may prioritize acute causes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of symptoms like pallor, improving the ability to capture the complexity of patient presentations and their underlying causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of symptoms like pallor, improving the ability to capture the complexity of patient presentations and their underlying causes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of symptoms like pallor, improving the ability to capture the complexity of patient presentations and their underlying causes.

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 R23.1?

Use R23.1 when documenting pallor that is not classified elsewhere, ensuring that the underlying cause is well-documented.